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PROGRAMMATIC MANAGEMENT OF v A case management built upon DOTS to DRUG-RESISTANT manage drug-resistance specifically Multi Drug-Resistant Tuberculosis TUBERCULOSIS (PMDT)
v Mainstreamed or integrated in the National TB Control Program of the Department of Health
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5 elements
DOTS
Sustained political commitment Quality microscopy service (DSSM) DOT/Supervised Treatment (1st line) Regular availability of 1st line drugs Standardized records and reports
PMDT
Sustained political commitment Quality assured DSSM, culture and DST DOT/Supervised Treatment (1st and 2nd line) Uninterrupted supply of quality assured 2nd line antiTB drugs and ancillary drugs Recording and reporting system designed for MDR-TB program 33
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Drug Resistant MONO Resistant- Resistance to one first line (Isoniazid, Tuberculosis drug Rifampicin, Pyrazinamide, Ethambutol) anti-TB
v POLY Resistant- Resistance to more than one 1st line anti-TB drug other than both H and R v Multi Drug-Resistant (MDR-TB)- Resistance to at least both H and R combination v Extensively Drug-Resistant- Resistance to at least H and R (MDR-TB) plus resistance to fluoroquinolones and one 2nd line anti-TB injectable (kanamycin, capreomycin, amikacin) v Total Drug Resistant- resistance to ALL available anti-TB 7/14/12 copyright 44 drugs
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March of Resistance
Susceptibl e TB MDR-TB 1990 XDR-TB 2006 TOTAL DR-TB ? Resistance to all available drugs No treatment options 55
Resistance to HR and 2nd line drugs Arises from mismanagemen t of MDR-TB treatment
SUSCEPTIBLE TB
MDR-TB
XDR-TB
Causative agent Mycobacterium Mycobacterium Mycobacterium tuberculosis tuberculosis tuberculosis Transmission airborne airborne airborne
Diagnosis
DSSM
Tx Success
More than 90% About 80% with Usually not under DOTS good MDR exceeding 50%; program manaement frequently incurable
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MDR-TB 18 to 24 months
Treatment side Mild to moderate Severe to toxic Severe to toxic effects (mild gastro (hearing loss, (hearing loss, intestinal psychosis, liver psychosis, liver disturbance) damage) damage)
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Fluoroquinolones
Oral bacteriostatic second line anti- Ethionamide (Eto) TB drugs Prothionamide (Pto) Cycloserine (Cs) Terizidone (Trd) Para-aminosalicylic (PAS) 7/14/12 copyright Thioacetazone (TH) 88
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B. New or Retreatment Cases 6. Symptomatic contact of a confirmed or suspected drug7/14/12 copyright 1212 resistant patient: A contact www.brainybetty.com
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Referral
v Fill out referral forms v TBDC as necessary v Refer patient at the Ilocos Training and Regional Medical Center DOTS Clinic / MDR-TB Treatment Center, Parian, San Fernando City, La Union v Contact Number: 09157112706 v Contact Person: Dr. Chester Directo (TC Physician) Mr. Alwin Abenoja (TC Nurse)
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Drug resistance in TB is a manmade consequence, therefore MDR-TB can be prevented with a strict adherence to the treatment regimens Therefore
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Thank you!
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