Management of multi-drug resistant tuberculosis: practitioner's view point

Multi-Drug Resistant Tuberculosis (MDR-TB) is a growing hazard to human health world wide and threat to control of tuberculosis. Current estimates report the prevalence of primary and acquired MDR-TB in India as 3.4% and 25% respectively. MDR-TB is suspected if sputum is persistently +ve for AFB along with clinical and radiological deterioration after multiple courses of irregular or regular treatment including 4 months of WHO retreatmant regimens under direct observation . Diagnosis is confirmed by drug susceptibility testing from reliable and reputed laboratories under constant quality control. Reports of susceptibility should not be accepted uncritically. Treatment of MDR-TB should be at a specialized centre with standard microbiology laboratory facilities. Though treatment guidelines including standardized, empirical and individualized approaches have been laid down by the WHO but therapy should be tailored to the needs of the particular patient. Treatment of MDR-TB is difficult, complicated, much costlier, challenging and needs experience and skills. All measures should be taken to persuade and encourage patients not to stop treatment despite all its discomforts to prevent morbidity, mortality and transmission of MDR-TB. Current proposal of DOTS Plus by WHO highlights the comprehensive management strategy to control MDR-TB. MDR-TB is a man-made problem and its emergence can be prevented by prompt diagnosis and effective treatment of all TB cases. Adoption of directly observed treatment short course (DOTS) to prevent the resistant/multi-drug resistant strains and careful introduction of second line drugs to treat patients with MDR-TB are the top priorities for the proper control of MDR-TB.