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Treatment of MDR-TB TRC Experience (1980-2005). Tuberculosis Research Centre (ICMR) Chennai. TRC ICMR. Tuberculosis Research Centre Chennai. Established in 1956

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treatment of mdr tb trc experience 1980 2005

Treatment of MDR-TB TRC Experience (1980-2005)

Tuberculosis Research Centre (ICMR)

Chennai

slide2

TRC ICMR

Tuberculosis Research CentreChennai

  • Established in 1956
  • Randomised clinical trials in pulmonary & EPTB
  • Rifampicin containing regimens used since 1974
  • Supranational reference lab. for mycobacteriology
  • Culture sensitivity available for all patients
  • Monitoring DOTS programme in a rural area since 1999
principles of management of mdr tb at trc

TRC ICMR

Principles of management of MDR TB at TRC
  • When patients were failing/relapsing, regimen was chosen based on the last susceptibility results available
  • Rx was changed according to patient response & susceptibility results
  • Choice of the regimen was based on the available drugs for managing MDR TB at the time
  • Rx was supervised for the first 6-month of injection phase thrice weekly
  • Subsequently, drugs were supplied once-a- week/fortnight and intake monitored by home visits
  • Patients were seen every month with clinical and bacteriological monitoring and X-ray once in 6-months
drugs for mdrtb

TRC ICMR

Drugs for MDRTB

Drug Dose (mgm)

  • Kanamycin 1000
  • Ofloxacin 400 – 600
  • Ethionamide 500
  • Cycloserine 500
  • Amikacin 500
  • Ethambutol 600 – 1200
  • PAS 10 gms
  • Thioacetazone 150
  • Isoniazid 600
contents

TRC ICMR

Contents

TRC experience in managing MDR TB

  • Pre-quinolone era
  • Quinolone era
  • Field experience
mdr management trc experience 1980 2002 rcts

TRC ICMR

Total pts. 218

Age 15 – 64 yrs ( Median 34 )

Sex - males 159 ( 73 % )

Weight range 24 – 69.5 kg (Mean 41.6)

MDR management TRC experience 1980 – 2002 (RCTs)
drug susceptibility profile among mdr pts n 218

TRC ICMR

Drug susceptibility profile among MDR pts (n=218)

Initial res.to HR 121

Acquired res.to HR 97

Initial res. to H 65

Initial res. to R 4

when to evaluate for mdr tb

TRC ICMR

When to evaluate for MDR TB ?
  • Patients not showing any reduction in bacillary population after 3-months of regular treatment with Cat II regimen
  • Sputum positive patients who are contacts of a known MDR TB patient
how to evaluate mdr tb

TRC ICMR

How to evaluate MDR TB ?
  • MDR TB is only a laboratory proved HR resistance
  • Clinical suspicion should be followed by lab. Confirmation
  • Laboratories should be quality controlled
drug resistance in tb

TRC ICMR

Drug Resistance in TB

When to suspect drug resistance?

  • Persistent sputum positivity
  • Fall and rise phenomenon of sputum AFB
  • Clinical or radiological deterioration in the presence of positive sputum

Provided patient has been regular in drug intake

management of mdr tb in the field

TRC ICMR

Management of MDR TB in the field
  • Basically 3 new drugs, S/K Eth O Z E
  • Initial hospitalisation at least for one month
  • Monthly supply of drugs given to respective PHI
  • DOT provider identified
  • TRC staff visits once a month
  • Pt attends TRC once a month for review
  • Clinical & bacteriological evaluation monthly
results

TRC ICMR

Results
  • Patients admitted from May 2000 – Dec’2003
  • No. of MDR-TB patients : 51
  • Males : 33 (65%)
  • Mean age in yrs : 38 (14-75)
  • Mean wt. In Kg : 41.7 ( 23.2-60.5)
slide34

TRC ICMR

Measures to improve Rx outcome

for MDR-TB

  • Standardised / Individualised treatment
  • Supervision
  • Hospitalisation
to conclude

TRC ICMR

To conclude
  • Availability of 2nd line drugs, including quinolone, alone was not adequate for managing MDR TB
  • Early detection, individually tailored regimen did not help to improve the Rx outcome
  • Directly observed treatment has given better results
  • Hospitalisation for the entire period of treatment has given better outcome
slide38

TRC ICMR

Recommendations

  • MDR TB should be always laboratory proved & Clinical suspicion should be followed by lab. Confirmation
  • Labs should be established in all states
  • Hospitalisation & supervision of Rx for the initial 3-6 mths of period is recommended for better outcome
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