Diagnosis and management of MDR-TB
®, MDR-TB
DISEASE
Diagnosis of MDR-TB is based on Gene Xpert® testing of sputum for identification of resistance to rifampicin (RR-TB) followed by culture and drug susceptibility testing (DST) for phenotypic characterization; however, treatment is started prior to the receipt of culture and sensitivity results due to long turnaround time of 10–16 weeks. Treatment options for MDR-TB/RR-TB currently include:Category 1—A bedaquiline-based injection-shorter treatment regimen (STR) (9 to 12 months) reserved for MDR-TB/RR-TB patients who have not been previously treated with second-line drugs and in whom resistance to fluoroquinolones and second-line injectable agents has been excluded. Drug options for shorter treatment regimen include an intensive phase of 4 months (extended to 6 months in case of delayed sputum smear conversion) containing high-dose gatifloxacin or moxifloxacin, kanamycin, prothionamide, clofazimine, high-dose isoniazid, pyrazinamide, and ethambutol followed by a continuation phase of 5 months containing gatifloxacin or moxifloxacin, clofazimine, ethambutol and pyrazinamide [Category 2—The longer treatment regimens (18 to 20 months) based on core backbone agents but individualized depending on age, fluoroquinolone resistance, and site of disease.According to standard of care, patients with MDR-TB are managed as in-patients at central MDR treatment facilities (which include Mulago and Lira hospitals) in the intensive phase of treatment after which they are discharged and required to report to the central MDR treatment facility monthly for review and drug refills. Following discharge, during the continuation phase, patients are required to report daily to the nearest private or public facility registered under DOT programme [