MODULE C
Introduction In Module B: Detect Cases of MDR-TB, you learned how to identify MDR-TB suspects and determine whether they have MDR-TB. This module describes how to treat MDR-TB or patients with confirmed resistance to anti-TB drugs. As with drug-susceptible TB, treatment for MDR-TB consists of two different phases of taking special combinations of drugs, particularly the intensive phase and the continuation phase. In the Philippines, patients who receive treatment for MDR-TB have regimens that are both individualized (designed according to the results of their drug susceptibility testing or DST) and empiric (based on history of anti-TB treatment). MDR-TB Treatment duration is much longer. A minimum of 18 months is required for each MDR-TB patient. The Treatment Center physician, along with the Consilium, will decide on the appropriate drugs to be used in the patient’s regimen. During the intensive phase of treatment, an MDR-TB patient takes at least 4 drugs deemed effective, including an injectable, depending on the DST results and/or the patient’s history of use of these drugs. During the continuation phase, the patient takes all of the drugs except the injectable. During both phases the drugs are taken every day except Sundays. Some patients acquire drug-resistant TB which develops while on previous treatments, either because supervised treatment was not done properly, the patient did not take the medications, or both. If the anti-TB drugs are taken incorrectly or irregularly, the patient will not be cured and further drug resistance may develop. Other patients contract a drug-resistant strain as a result of transmission from a person with MDR-TB. Once a patient has confirmed drug resistance it is vital that MDR-TB patients take all their medications correctly to be cured minimizing the risk of relapse. The treatment of MDR-TB in many of these patients represents the last opportunity for them to be cured, and in many cases, the last opportunity to continue living. MDR-TB can have high mortality rates because most patients have been chronically ill. If MDR-TB patients are left to take drugs by themselves, at least 30% will not comply with their treatment (that is, take the treatment as directed). Predicting who will or will not comply is difficult. Health workers must take an active role to ensure that every patient takes the recommended drugs, in the right combinations, on the correct schedule, for the appropriate duration. The best way to ensure this is for a trained health worker or a community TB treatment partner to observe each patient swallow the drugs. This is called directly observed treatment (DOT, also known as fully supervised treatment). Supervised treatment for MDR-TB patients is necessary throughout the entire regimen. This takes place in the Treatment Center for patients who are still sputumpositive. Once a patient has culture converted (become culture-negative) for at least one month, and the current smears are negative, the patient will be decentralized. Once decentralized, the patient will usually receive treatment during the week at his or her local DOTS facility which is called a Treatment Site for the remainder of treatment as long as the treatment continues to progress as planned. On Saturdays and holidays, when the Treatment Sites are closed, the MDR-TB patient will receive the dose at the Treatment Center unless a community treatment partner such as a barangay health worker or a volunteer is able and willing to provide supervised treatment outside the Treatment Site. The patient must be evaluated by the Treatment Center physician at least monthly.
Treat MDR-TB Patients
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