Challenges in the management of drug- resistant tuberculosis

29 Aug 2024 08:50 09:10
Rex Room, Level 6
Mat Zuki Mat Jaeb Speaker Malaysia

Multidrug-Resistant Tuberculosis Workshop
CHALLENGES IN THE MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS

Mat Zuki Mat Jaeb
Raja Perempuan Zainab II Hospital, Kota Bahru, Kelantan, Malaysia

Despite more advanced diagnostic tests and new treatment regimens available, management of DR-TB remain challenging which lead to unfavourable treatment outcome. 

Mycobacterium tuberculosis ability to adapts physiological changes during infection present challenges for TB drug efficacy, which result in drug resistance. 

Phenotypic drug susceptibility testing (DST) traditionally used for TB, takes long time for the result to be available and more recently, molecular diagnostics for DST have been implemented with major advantages on ease of use, speed of diagnosis and resistance detection however, given complexity of genetics in TB drug resistance, a single molecular diagnostic is not sufficient to cover the full spectrum of mutations associated with the large number of drugs/drug classes that are used to treat DR-TB. 

Access to drug susceptibility tests for second-line drugs remains the major issue for National TB control program. Phenomenon of heteroresistance further complicating the diagnosis and management of DR-TB, which refers to the co-existence of susceptible and resistant mycobacterium tuberculosis variants, or of multiple resistant strains with discrete resistance-conferring mutations. 

The long duration, multiple drugs and complicated drug regimen also have contributed to the challenges facing in DR-TB treatment, especially on adverse event as they influence treatment adherence. DR-TB treatment is also inhibited by the cost factor and access to newly approved drugs. 

Better outcome of DR-TB treatment may be achieved with more advance, rapid and accurate diagnostic tests together with effective, shorter duration, less toxic drugs for DR-TB treatment. 

Referrences: 

  1. WHO. Global tuberculosis report 2021. https://www.who.int/ teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2021 

  2. Stephanie, F.; Saragih, M.; Tambunan, Pharmaceutics 2021, 13, 592. htps://doi.org/10.3390/ pharmaceutics13050592 

  3. Bagcchi, S. WHO’s Global Tuberculosis Report 2022. Lancet. Microbe 2023, 4, e20. 

  4. Warner DF: Cold Spring Harb Perspect Med 2014. 

  5. Metcalfe JZ et al. Am J Respir Crit Care Med 2017, 196:1191-1201.