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Multidrug-Resistant Tuberculosis

Patrick M. Zito, PharmD, DO Reviewed 05/2023
 


BASICS

DESCRIPTION

  • Multidrug-resistant tuberculosis (MDR-TB) is disease that is resistant to first-line medications: isoniazid, pyrazinamide, streptomycin, ethambutol, and rifampin.

  • Extensively, drug-re...

DIAGNOSIS

HISTORY

  • Sexual history

  • Prior positive purified protein derivative (PPD) test, TB treatment, TB exposure, travel to an area where TB is endemic, homelessness, or incarceration

  • Dyspnea

  • Chest pain

  • H...

TREATMENT

GENERAL MEASURES

  • Begin empiric TB treatment with a four-drug regimen (pending culture and sensitivities): isoniazid, rifampin, pyrazinamide, either ethambutol or streptomycin. The fourth drug...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Follow the patient 2 years after completing treatment.

  • Close contacts may need prophylaxis as per infectious disease recommendations.

DIET

Adequate...

REFERENCES

1
Centers for Disease Control and Prevention. Drug-resistant TB. Last reviewed October 13, 2022. Accessed April 24, 2023. https://www.cdc.gov/tb/topic/drtb/default.htm

ADDITIONAL READING

World Health Organization. Drug-resistant TB. Accessed April 24, 2023. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-re...

CODES

ICD10

A15.8 Other respiratory tuberculosis 

SNOMED

423092005 Multidrug resistant tuberculosis 

CLINICAL PEARLS

  • Consider TB/MDR-TB for any patient presenting with an infectious lung process, particularly with hemoptysis.

  • Start empiric therapy prior to sputum culture results if TB is suspected.

  • Fiv...

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