TB

Question 1

MDR TB treatment Regimen

Answer 1

MDR-TB = Multi-drug resistant

• TB - Resistance to both isoniazid and rifampicin

“Bangladesh” regimen: short course treatment for MDR-TB

• Controlled trial confirmed efficacy of 4 month intensive phase and 5 month continuation phase
• Short course versus optimized background long course:
  
  • Mox 800, Clofaz, E, Z, with kanamycin, high dose H, prothionamide for 1st 16x weeks -> 33% with HIV infection
• Primary outcome at 132 weeks: non inferior (78.8% vs 79.8%)
• But increasing resistance to components of this regimen
• Only 10% of MDR-TB patients in USA meet requirements for short course
  
  • Good for very selected patients but not for most patients
• New all oral treatment
  
  • ​Amikacin only if can’t make effective regimen

Question 2

Consequence of not using Pyrazinamide in TB

Answer 2

Treatment must be prolonged to 9 months (from 6 months)

Question 3

Drug Resistance in TB

Answer 3

• Multi-Drug Resistant (MDR) TB - defined by resistance to Isoniazid and Rifampicin
  
  • 1.7% in Australia (3.3% worldwide)
• Extensively Drug Resistant (XDR) TB - defined by Rifampicin and isoniazid and Quinolones and Injectable (1 of: Amikacin, Kanamycin, Capreomycin)
  
  • 10% of MDR is XDR
  • worse outcomes, mortality 20%

Question 4

Consequence of not using Pyrazinamide in TB

Answer 4

Treatment must be prolonged to 9 months (from 6 months)

Question 5

Drug Resistance in TB

Answer 5

• *Multi-Drug Resistant (MDR) TB** - defined by resistance to Isoniazid and Rifampicin
• 1.7% in Australia (3.3% worldwide)
• *Extensively Drug Resistant (XDR) TB** - defined by Rifampicin and isoniazid and Quinolones and Injectable (1 of: Amikacin, Kanamycin, Capreomycin)
• 10% of MDR is XDR
• worse outcomes, mortality 20%

Question 6

Latent TB

• Epidemiology
• Lifetime risk of progression
• Ix
• Who to treat, which drug

Answer 6