Disease Information for Multiple drug resistant Tuberculosis

Multidrug-resistant (MDR) tuberculosis is caused by Mycobacterium tuberculosis bacilli resistant at least to isoniazid and rifampin; The clinical management of MDR tuberculosis with second-line drugs [aminoglycosides, capreomycin, cycloserine, fluoroquinolones, para-aminosalicylic acid (PAS), and thioamides has remained relatively unexplored; Drug Resistance in Patients with Non-MDR Tuberculosis: Tuberculosis due to a mycobacterial strain resistant to a single drug (except when that drug is rifampin) should be treated with first-line agents; In contrast, patients with rifampin-resistant disease should be managed as MDR tuberculosis cases; Non-MDR, polydrug-resistant cases (caused by an isolate resistant to first-line and/or second-line drugs) pose a clinical challenge whose magnitude depends on the level of drug resistance; In these cases, the patient should receive chemotherapy tailored to drug susceptibility results; Treatment regimens should include at least four drugs to which the isolate is susceptible, including rifampin and as many

first-line drugs as possible; High-dose isoniazid treatment may be considered for patients whose susceptibility results indicate an isoniazid minimum inhibitory concentration of 01-02 g/mL [Update by Dr Michael D Iseman/Merck Medicus Search 6/05]

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