CRA15 A CASE SERIES OF MULTIDRUG-RESISTANT TUBERCULOSIS

Norsyuhada zaharudin1, Yong Mei Ching 2, Kho Sze Shyang2
1.Medical Department, Bintulu Hospital
2.Respiratory Unit, Medical Department, Sarawak General Hospital

Introduction

Globally, the estimated annual number of people who developed MDR/RR TB was relatively stable.[1] In Malaysia, the incidence of MDR-TB was 0.34% among patients with tuberculosis infection Since 2022, World Health Organization (WHO) recommended two new treatment regimens: 6-month all-oral regimen composed of bedaqulinine, pretomanid, linezolid and moxifloxacin (BPaLM) and 9-months all-oral regimen in patients with MDR/RRTB in whom resistance to fluoroquinolones has been excluded. Longer (18-month) treatment remains a valid option in cases where shorter regimens cannot be implemented.[2, 3]

Objective

To describe the MDR TB treatment in our local setting.

Methodology

We identified six patients with a diagnosis of MDR TB from TB culture. The regimens, treatment duration, timing of culture clearance and outcome are recorded.

Results 

All patients were diagnosed with pulmonary MDR TB. The patient’s age ranged from 23-70 years old. One patient had previous treatment for pulmonary TB, and another had contact with MDR TB. All were tested negative for HIV. 

All patients except for one received a seven-drug regimen. Four of six patients had an injectable agent (Amikacin) in the treatment regime. Three patients received standard local treatment with pyrazinamide, levofloxacin, amikacin, ethionamide, cycloserine, clofazimine and Ethambutol. Two patients had an all-oral regimen where amikacin was replaced with bedaquiline. One patient received both amikacin and bedaquiline given persistent positive culture. The intensive phase ranged between 20 to 24 weeks, and the total duration of therapy was 56 to 72 weeks. The timing of culture clearance ranged from 1-3 months. 83% of patients are alive and completed treatment to date except one patient who succumbed, due to acute coronary syndrome.

Conclusions

Even though the WHO all-oral recommendation regimen is shorter, more acceptable and easier to administer, it remains a challenge for full implementation. Individualized MDRTB treatment based on resource availability and patient characteristics should be considered.