Rifampicin-resistant Mycobacterium tuberculosis: Susceptibility to isoniazid and other anti-tuberculosis drugs
Kurbatova, International Research and Programs Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 03/2012; 16(3):355-7. DOI: 10.5588/ijtld.11.0542
Based on data from 14 Supranational Tuberculosis (TB) Reference Laboratories worldwide, the proportion of rifampicin (RMP) resistant isolates that were isoniazid (INH) susceptible by phenotypic drug susceptibility testing varied widely (0.5-11.6%). RMP-resistant isolates that were INH-susceptible had significantly lower rates of resistance to other first- and second-line anti-tuberculosis drugs (except rifabutin) compared to multidrug-resistant isolates. RMP resistance is not always a good proxy for a presumptive diagnosis of multidrug-resistant TB, which has implications for use of molecular assays that identify only RMP resistance-associated DNA mutations.
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ABSTRACT: Multidrug-resistant tuberculosis (TB) in children is mainly caused by transmission of drug-resistant strains causing infection and disease (i.e., primary drug-resistant TB) and, therefore, follows adult multidrug-resistant TB trends. Diagnosis is made by culture and phenotypic or genotypic drug susceptibility testing, either from the child's or the adult source case's Mycobacterium tuberculosis isolate. Treatment is mainly with second-line anti-TB drugs, building a regimen with four effective drugs; the principles of management are the same as for adults. Monitoring for adverse events is important as second-line drugs are more toxic than first-line treatment. With early diagnosis and treatment, outcome is better than in adults. New drugs and drug combinations are in development and should also be evaluated in children.
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ABSTRACT: Tuberculosis takes a heavy toll of ~5000 lives every day from the disease; responsible for the 86% of DALY burden. Despite having drugs to treat TB efficiently, we have failed to control the disease. Mycobacterium tuberculosis has exploited it to their advantage evolving with multiple mutations making it resistant to first-line and second-line drugs. Most of the high-burden countries are low-medium income countries, their national TB program (NTP) still use sputum smear microscopy as the tool of diagnosis. Many new molecular tools are emerging, but confuse the larger TB clinical scientific community at the NTPs. Coherent information need to be disseminated, encouraging TB scientific community to generate evidences within NTPs assessing new tools through critical analyses in terms of value addition and cost benefit before considering rolling out in the program. It is also imperative that the scientific community need to have an open mind to use different tools in the right permutation and combination than being exclusive of one another. This article portrays an overview of the diagnostics landscape in 2012 with pros and cons of different tools to be able to generate a step-wise algorithm for optimal exploitation of the tools within available resources in each of the settings.
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