There is no convincing guidelines on how I can approach total drug resistance accordingly. So how do we manage patients who are resistant to medication for XDR - TB?
Use any group 1 agent* that may be effective and the strain
1. is susceptible
2.Use an injectable agent to which the strain is susceptible
3.Use later generation fluoroquinolone such as moxifloxacin
which does not have resistance to tubercular bacilli
4.Use any two group 4 agents which are likely to be
effective
5.Use 2 or more agents from group 5
6. Consider high dose isoniazid if low level resistance is documented
7. Consider adjuvant surgery if there is localised disease
8. Ensure strong infection control measures
9. Treat HIV
Group 1:Isoniazid, rifampicin,pyrazinamide
Group 4;Ethinomaide,Protionamide,cycloserine,PAS
Group 5;Clofazimine (Cfz)
Linezolide (Lzd)
Amoxicillin/clavulanate (Amx/Clv)
Thioacetazone (Thz)
Clarithromycin (Clr)
Imipenem (Ipm)
High dose isoniazid
Scientifically arguing there is NO TOTALLY RESISTANT TB. At present in vitro we have tested ONLY FEW drugs against MTB. There are many more drugs and combinations which we have not tested or used as therapy. Still there is light in the distant horizon for all of us, we can find a newer molecule which may be effective against MTB and does not develop resistance like the presently available ATDrugs. Our greedy attitude and mis use of the antibiotics has resulted in the present grim situation. I hope we will not commit similar blunder again.
Injectable drugs are effective against MTB. Because of the long duration and thepatient has to go to a medical practitioner to receive the injection daily, these injects less and their combinations
I had experience in vitro several herbal medicine againts Mtb......do you need this information..?
I agree with Vijay Kumar that scientifically arguing there is NO TOTALLY RESISTANT TB.
Dear colleague,
I agree with previous comments. There's no "totally resistant" M. tuberculosis strain. Individual treatment strategy may be defined according to specifical resistance pattern of each strain. It would be important to know which antibiotic were tested in your patient.
I would strongly suggest following your country's guidelines on the treatment of XDR TB or "Totally" resistant TB. The costs and duration involved would break the economic backbone of most families in the developing world (and that includes my country, India). The pros of using your country's TB programme are free drugs, free testing including follow up cultures during IP & CP and hospitalisation if required. The cons are that it is a fixed regime, which does not take into account susceptibility profiles of individual drugs, other than the marker drugs.
If you prefer to used an individualised regime, go with Bhupinder Singh Kalra's suggestion.
So difficult to imagine a totally resistant population of bacilli to anti-tb drugs. The growing field of pharmacotherapy is giving new drugs in this indication and some old ones such as clofazimine are now used in some counties. The treatment of resistant TB as to be personalized, that is the best option to my opinion
to Dr. Lawrence we use genexpert for anti TB medication resistance besides culture and AFB for diagnosis
in our set up in order to Dx MDR TB besides AFB and Culture we do rifampin and Isoniazid sensitivity/resistance test.
For XDR TB : we do the following : sensitivity/resistance test for all first line anti TB medications in addition to levofloxacin, amikacin, ethionamide, and cycloserin
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