DRUG Resistant Tuberculosis

Tuberculosis bacteria might be resistant to one or many drugs which are commonly used for treatment. Recently, the chances of having drug resistance has increased to approximately 15-20%. Hence, it is important to investigate a child with tuberculosis prior to starting treatment.

What is Multi Drug Resistant TB or MDR-TB?

When the TB bacteria is resistant to at least Rifampicin and Isoniazid it is called as MDR Tuberculosis

When should a Drug Resistance be considered?

Drug resistance should be considered in the following circumstances:

  • Poor response to first line therapy: Poor response to treatment in a patient taking drugs as per a correct regime
  • Treatment after lost to follow up (also called as Defaulter): child has already received TB medicines for at least one month and then has stopped treatment.
  • Recurrent TB (Relapse): Child who been detected with TB in past and now has got a recurrence.
  • Children in contact of MDR TB adult patients

How to evaluate a child if Drug Resistance is suspected?

Children suspected of having Drug Resistant TB should be evaluated at specialized centres only. Detailed microbiological investigations are required namely: GeneXpert MTB PCR, MGIT TB cultures and Drug Sensitivity and Line Probe Assay (also called as Hain’s Test) on appropriate specimens like sputum, FNAC aspirates, bronchoalveolar lavage etc.

How is Drug Resistant TB treated?

Treatment of drug resistant TB is complex and depends on the detailed testing mentioned above. The treatment requires second line TB drugs to be given for 18 month to 2 years.