Management of Drug-Resistant Tuberculosis: Q&A for Primary Care Physicians

Authors: Sujeet Rajan, MD—co-author
Madhukar Pai, MD, PhD—Author and Series Editor
Number of pages: 5
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Overview: Drug-resistant TB (DR-TB) is a serious and growing threat in India, especially in urban areas such as Mumbai. Multidrug-resistant TB (MDR-TB) is resistance to two of the most important first-line anti-TB drugs – isoniazid and rifampicin. Some patients develop more severe forms of DR-TB. Extensively drug-resistant TB (XDR-TB) is resistance to isoniazid and rifampicin, plus any fluoroquinolone, and at least one of 3 injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). DR-TB occurs when patients fail to complete first-line drug therapy, have relapse, or newly acquire it from another person with DR-TB. If patients have any risk factors for drug-resistance, or live in a high MDR-TB prevalence area (e.g., Mumbai city), or do not respond to standard drug therapy, they must be investigated for MDR-TB using drug-susceptibility tests (DST) like GeneXpert, line probe assays, and liquid cultures. MDR-TB requires long-term and specialized treatment. So, patients should be referred to specialists, either in the private sector, or in the public sector where free MDR treatment is available. This Q&A covers commonly asked questions by the primary care doctor about identification and referral of patients with suspected or confirmed DR-TB.

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