Problem

Drug-resistant tuberculosis

Other Names:
Multiply drug-resistant TB
Re-emergent tuberculosis
Nature:

Tuberculosis management refers to the medical treatment of the infectious disease tuberculosis (TB).

The standard "short" course treatment for TB is isoniazid (along with pyridoxal phosphate to obviate peripheral neuropathy caused by isoniazid), rifampicin (also known as rifampin in the United States), pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone for a further four months. The patient is considered to be free of living bacteria after six months. For latent tuberculosis, the standard treatment is six to nine months of daily isoniazid alone or three months of weekly (12 doses total) of isoniazid/rifapentine combination. If the organism is known to be fully sensitive, then treatment is with isoniazid, rifampicin, and pyrazinamide for two months, followed by isoniazid and rifampicin for four months. Ethambutol need not be used.

Incidence:
Hospital staff in developed countries do not expect tubercular patients. In Italy, the sanatoria for TB victims was dismantled in the 1970's. Hospital staff may fail to isolate tubercular patients or decontaminate equipment properly to prevent the spread of the disease. In addition, their tuberculosis is now often virtually untreatable, being deadlier than both the Ebola virus and the bubonic plague.

Doctors may fail to prescribe the full range of drugs required and the patient stops taking drugs when he feels better, even though he may not be cured. These two practices enhance drug resistance.

It will cost governments and the drug industry $500 million a year to prevent a resurgence of tuberculosis. One therapy that works is DOTS, or directly observed treatment short-course, which involves monitoring the patient's drug-taking over the entire lengthy course of treatment.

Treating normal tuberculosis costs about $11 per patient, but medicines for drug-resistant TB can cost up to $250,000 per patient and still fail to cure him. Obviously, it is critical to cure TB before it becomes drug-resistant.

Problem Type:
G: Very specific problems
Date of last update
27.12.2017 – 18:51 CET