This child has pre-extensively drug resistant {XDR} TB with resistance to both HR and even quinolones. Multidrug-resistant {MDR} TB implies resistant to both
Isoniazid and
Rifampicin whereas XDR TB implies MDR TB with additional resistance to at least a fluoroquinolones and one of the injectables i.e. kanamycin,
Amikacin or capreomycin. {1} Since she has resistance to quinolones but not to aminoglycosides, she has pre- XDR TB. She would need to be started on second line ATT. Drugs are chosen with a stepwise selection process through five groups. Among the first group {the oral first-line drugs} high-dose isoniazid,
Pyrazinamide and
Ethambutol are thought of as an adjunct for the treatment of MDR and XDR tuberculosis. The second group is the injectable drugs {capreomycin, kanamycin, amikacin}. The third group include the flouroquinolones. The fourth group are called the second-line drugs {thionamide,
Cycloserine and aminosalicylic acid}. The fifth group includes drugs that have sparse clinical data {clofazimine,
Amoxicillin with clavulanate, linezolid, carbapenems, thioacetazone and clarithromycin}. {2} In this child since all the first line drugs were resistant, the child was treated with amikacin, cycloserine, PAS, clofazamine and linezolid. She received injectable for 6 months and remaining drugs for 20 months. She responded to her therapy.
| References : |
- World Health Organization (WHO) Global Tuberculosis Control Report 2011. Available at website: http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf. Accessed on 8th March 2012
- Caminero JA, Sotgiu G, Zumla A, Migliori GB. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. Lancet Infect Dis. 2010; 10: 621-629.
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