EPIDEMIOLOGY AND

PROPHYLAXIS OF

MDR & XDR

• Multi-drug-resistant tuberculosis (MDR-TB) is
defined as - tuberculosis that is resistant to
at least isoniazid (INH) and rifampicin.
• The two most powerful first line treatment
anti TB drugs
• When the course of antibiotics is interrupted
levels of drug in the body are insufficient to
kill 100% of bacteria.
• Most commonly develops in the course of Tb
treatment:
• Inappropriate treatment
• Missing dose or
• failing to complete their treatment
• Multidrug-resistant strain can transmit TB if
pathogens are alive & patient coughing
• TB strains-often less fit & less transmissible &
outbreaks occur more readily in people with
weakened immune system (HIV)
• PREVENTION OF DRUG RESISTANCE TB
• Rapid diagnosis & treatment of TB:
• One of the greatest risk factors. especially in developing countries
• If TB is identified & treated soon drug resistance can be avoided

• Completion of treatment:
• Previous treatment of TB is an indicator of MDR TB.
• Incomplete antibiotic treatment or improper prescription of antibiotic
regimen-resistance can develop
• Drugs that are of poor quality or less in quantity especially in
developing countries contribute to MDR TB
• EXTENSIVELY DRUG RESISTANT- XDR-TB

• XDR-TB is defined as TB that has developed resistance to at

least rifampicin and isoniazid, as well as to any member of
the quinolone family and at least one of the following second-
line anti-TB injectable drugs:
• Kanamycin
• Capreomycin
• Amikacin
• TB bacteria are found in the sputum ,diagnosis of TB can
be made in a day ,but we can't distinguish between drug-
susceptible & drug-resistant TB.
• To evaluate drug susceptibility, bacteria need to be
cultivated ,tested in a suitable Laboratory. Final diagnosis
in this way for TB & especially for XDR-TB, may take from
6 to 16 weeks
• Drug Susceptibility Testing (DST) is capable of determining
how well four primary All first line anti-tubercular
drugs(ATT) inhibit the growth of Mycobacterium
Tuberculosis
 TREATMENT
• REGIMEN UNDER DOTS PLUS PROGRAMME IN INDIA
• INITIAL INTENSIVE PHASE 6-9 months
• Inj Kanamycin Tab Ethionamide Tab Ofloxacin Tab. Pyrazinamide
Tab. Ethambutol Cap Cycloserine
• CONTINUATION PHASE 18 months
• Tab Ethionamide Tab Ofloxacin Tab Ethambutol Cap Cycloserine
• SECOND LINE TB DRUGS
• GROUP A
• Levofloxacin (Lfx) or Moxifloxacin (Mfx) , Bedaquiline (Bdq) ,Linezolid (Lzd)
• GROUP B
• Clofazimine (Cfz) ,Cycloserine (Cs) or Terizidone (Trd)
• GROUP C
• Ethambutol (E) ,Delamanid (Dlm) ,Pyrazinamide (Z)
• Imipenem-cilastatin (Ipm-Cln) or
Meropenem (Mpm)
• Amikacin (Am) (or Streptomycin)Ethionamide (Eto)
• p-aminosalicylic acid (PAS)
THANKYOU