Prevention
MDR-TB can occur in two ways:through incorrect treatment of TB (via misdiagnosis or low treatment adherence) or when MDR-TB is present in the community and the airborne disease spreads to others. The best practice for prevention is to ensure that TB patients complete their treatment course (ALA, 2013).
To prevent the spread of MDR-TB, CDC recommends inhibiting exposure to MDR-TB cases in crowded areas, such as hospitals, prisons and homeless shelters (CDC, 2012).
Surveillance of MDR-TB in the United States and Worldwide In 1993, the CDC expanded its TB surveillance system to include MDR-TB cases. Additional information about the National TB Surveillance System can be found at: http://healthindicators.gov/Resources/DataSources/NTBSS_120/Profile.
WHO also monitors the incidence of drug resistance in TB. Most recently, they began reporting on the progress of treating MDR-TB. WHO reports and publications can be found at http://www.who.int/tb/publications/mdr_surveillance/en/.
Treatment
MDR-TB occurs when TB is not treated correctly or the patient does not adhere to their medication regimen. The best practice for prevention is to ensure that TB patients complete their treatment course (ALA, 2013). Once MDR-TB is present, it must be treated to prevent further health issues for the patient and to prevent the spread of MDR-TB to others in the community. The main obstacle for MDR-TB treatment is medication adherence. Treatment may involve taking multiple medications for up to two years that include adverse side effects such as headache, upset stomach, dizziness and skin rash (North Dakota Department of Health, 2013).
Direct Observation Therapy (DOT)
DOT is a process where medication adherence is observed. Practitioners use DOT on a wide range of TB cases, from latent TB in children to active MDR-TB patients. Once the treatment course is prescribed, a trained healthcare worker gives prescribed TB drugs to the patient and then observe the patient swallow the drugs or receive the injection. Healthcare workers may also check for side effects and ensure the patient is healthy. Therapy may occur anywhere from just the first two months of therapy to the full course of treatment. Additional Information on DOT can be found at: http://www.health.state.mn.us/divs/idepc/diseases/tb/lph/dot.pdf.
Although DOT ensures adherence, it is labor intensive and time consuming for both the patient and the health system. Many organizations have begun researching other ways to conduct DOT, such as video monitoring, time-released pill bottles and even ingestible sensors (Belknap R, Weis S, Brookens A, Au-Yeung KY, Moon G, et al., 2013).
The video below provides a brief report on the use of DOT and fingerprinting to treat and control TB in India.
Surgical Therapy
According to a literature review funded by the National Institutes of Health (NIH) and the Atlanta Clinical and Translational Science Institute, no randomized controlled trials using artificial pneumothorax surgery in combination with antibiotic treatment on MDR-TB have been conducted, but based on the trends in the research conducted thus far, it is reasonable to consider surgical resection early in the course of treatment.
Surgical therapy may be an option for MDR-TB patients that meet the following criteria:
- Such extensive drug resistance that there is a high likelihood of treatment failure or relapse
- Localized disease amenable to resection 3) Sufficient drug activity to reduce remaining mycobacterial burden enough to allow bronchial stump healing.
Other considerations:
- Surgery for tuberculosis should only be performed at specialized surgical facilities or experienced thoracic surgeons.
- No research has been conducted on the efficacy of surgery specifically on immuno-compromized patients (Kempker, R., Vashakadze., Solomonia, N., Dzidzikashvili, N., Blumberg, H., 2013).