Multi-Drug Resistant and Extensively-Drug Resistant Tuberculosis
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REVIEW ARTICLE
Multi-Drug Resistant and Extensively-Drug Resistant Tuberculosis Ira Shah 1 & Vishrutha Poojari 1 & Himali Meshram 1 Received: 27 December 2019 / Accepted: 30 January 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract India is one of the high burden countries for tuberculosis (TB) including multi-drug resistant TB (MDR-TB) and extensivelydrug resistant (XDR) TB. Drug-resistant (DR) TB has threatened the TB care and is a major health problem in many countries; treatment of DR TB has been difficult requiring use of reserve or second-line drugs, cost factors, has extensive side-effect profile and long duration of treatment. Treatment in MDR-TB are increasingly becoming individualised mainly due to preference for oral over injectable, results of drug susceptibility testing (DST), population resistance levels, history of previous TB treatment, drug tolerability and drug-to-drug interactions. Bedaquilline (BDQ) and delaminid (DLM) are new drugs available for treatment of these patients. World Health Organization (WHO) recommends use of BDQ in more than 15 y (>15 kg) patients only. Under Revised National Tuberculosis Control Programme (RNTCP) the use of this drug is recommended for patients older than 18 y only. Under RNTCP, the use of DLM is approved in children 6 y and above. Pediatric MDR/XDR TB treatment outcome with newer anti-TB drugs and regimen is lacking. Children when treated with individualized regimens have improved survival. Keywords India . Children . Tuberculosis (TB) . Multidrug resistant TB (MDR-TB) . Extensively-drug resistant TB (XDR-TB) . Treatment
Introduction Tuberculosis (TB) is an old disease and continues to be the leading infectious cause of death worldwide [1]. India is one of the high burden countries for tuberculosis (TB) including multi-drug resistant TB (MDR-TB) with estimated incidence of 2.790 million cases of TB in 2016 [2]. Estimated MDR pulmonary TB cases reported from India in the year 2016 were 147,000 with 2.8% of new cases and 12% cases were previously treated [3]. Globally in the year 2017, around 558,000 people (483,000-639,000) developed rifampicinresistant (RR) TB of which 82% had MDR-TB and 8.5% cases of MDR-TB were estimated to have extensively-drug resistant (XDR) TB [1]. India (24%), China (13%) and Russian federation (10%) account for half of the world’s drug resistant (DR) TB cases [1]. Data on pediatric MDR-TB is scarce. As per Dood et al., in 2014 there were 850,000 children diagnosed with TB of which 25,000 children were
* Ira Shah [email protected] 1
Pediatric TB and DR-TB Clinic, Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children, Mumbai 400012, India
diagnosed with MDR-TB and 1200 with XDR-TB [4]. In the author’s centre, the prevalence of DR-TB was 9.6% in 2016 among all patients with TB which has been increasing over the years [5]. Some of the factors responsible for the increased incidence of TB are undernutrition, human immunodeficiency virus (HIV) infection; eliminating extreme poverty can substantially redu
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