Treatment in the modern era of resistance
Abstract number: 1133_20
Drug resistant, and particularly multiple-drug resistant tuberculosis (MDRTB) is increasing globally particularly in Eastern Europe, but the actual incidence is unknown. Countries with effective TB programmes see low rates of MDRTB amongst new cases annually. Hot spots with high rates such as countries of the former Soviet Union exist and modelling of existing data suggest that between 250500 000 new MDRTB cases occur globally. MDRTB is particularly difficult to treat, particularly when co-existing with HIV infection, and carries a high mortality compared to drug sensitive disease. Although modern rifampicin-based short course treatments are effective against drug sensitive and mono-resistant disease (apart from rifampicin resistance), MDRTB therapy is difficult and prolonged. Survival requires therapy with at least three agents to which the bacteria are susceptible. New research has produced many rapid and novel methods to diagnose drug resistance earlier which may confer some survival or public health advantage as may other processes that reduce diagnostic delay including the reduction of stigma. In high income countries, individualised therapy forms the gold standard of treatment but the substantial laboratory costs associated with this approach have led to studies of standardised treatment in middle/low income countries. Studies in Peru examined both approaches with comparable success. Nevertheless even standardized treatment requires an accurate survey of drug resistance and an understanding and correction of the initial causes of high rates of MDRTB. Few new drugs are available for treatment and the individual and health system costs of treating drug resistant cases are high emphasising the critical importance of curing drug sensitive tuberculosis at first presentation. The presentation will discuss some of the management options available for the treatment of resistant disease.
|Session name:||XXIst ISTH Congress|
|Back to top|