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Multidrug resistant tuberculosis (MDR-TB): an update
Published on November 28, 2021 36 min
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Hello, my name is Simon Tiberi, I'm an infectious diseases consultant working at Barts Health, the Royal London Hospital and Queen Mary, University of London. I'm going to talk to you about drug-resistant TB, global situation and management, and give you an update of what's new in this field.
Briefly, I would like to outline some of our objectives for today. I'm going to be talking about the drug resistant TB treatment strategies and principles. I'll give you the latest WHO categorisation of anti drug-resistant TB drugs. We will go through the steps of building a drug-resistant TB treatment regimen together, and we will discuss Consilia, an advisory service for challenging cases.
First, some definitions. The first definitions we use are abbreviations. HR means isoniazid resistance, RR means rifampicin resistance, MDR-TB is multi-drug resistant TB, which is TB that is resistant to isoniazid and rifampicin. Pre-XDR TB is a new definition meaning pre-extensively drug-resistant TB - which has just been released by the World Health Organization in October 2020 - and that means resistance to isoniazid, rifampicin, and a later-generation fluoroquinolone. Now there's a new definition of extensively drug-resistant TB, previously it was isoniazid and rifampicin resistance, together with a later-generation fluoroquinolone and a second-line injectable aminoglycoside, now the second-line injectable aminoglycoside has been replaced by either linezolid or bedaquiline. These are new definitions, because the landscape and the way we treat drug-resistant TB has now changed.