TB mdr is a condition that makes TB people resistant to drugs

Definition

What is MDR TB (multiple drug resistant)?

Tuberculosis (TB) is a contagious disease caused by a bacterial infection Mycobacterium tuberculosis. People who contract tuberculosis (TB) must be disciplined in undergoing treatment. The reason is, if you do not comply with the rules for taking TB medicine properly, the patient's condition can worsen and experience resistance (resistance) to antibiotic drugs or also known as MDR TB (multiple drug resistant).

An antibiotic resistant condition means that the bacteria are no longer affected by the antibiotic reaction. As a result, the drugs given are no longer effective in curing bacterial infections.

When a person is resistant to anti-tuberculosis drugs, the treatment becomes more complex and thus takes longer to recover. Treatment for MDR tuberculosis also has more severe side effects.

Patients who experience MDR TB are usually patients who are resistant to the first-line TB drugs, namely isoniazid (INH) and rifampin. Both of these antibiotics work most effectively to stop the bacterial infection that causes tuberculosis. However, it does not rule out if the patient can also be resistant to other first-line drugs, such as ethambutol, streptomycin, and pyrazinamide.

MDR tuberculosis is generally characterized by worsening tuberculosis symptoms such as persistent coughing up to coughing up blood, shortness of breath, low-grade fever, and night sweats.

How common is drug resistant TB disease?

MDR TB is a health problem that is still a serious threat. In developing countries - especially areas where TB is a common disease - the incidence of MDR TB is quite high.

According to a study from Tropical Diseases Travel Medicine and Vaccines , in 2016, there were as many as 4.1% of cases of drug-resistant tuberculosis that appeared for the first time, and 19% of cases of MDR tuberculosis that developed from ordinary TB. There were an estimated 240,000 deaths from TB drug resistance in the same year.

Meanwhile, quoted from the website of the World Health Organization (WHO), as many as 117 countries in the world have reported cases of TB drug resistance. Countries with the highest incidence of MDR tuberculosis are China, India, and Russia.

The high number of drug-resistant TB sufferers is triggered by a variety of factors. Some of the triggers for MDR TB are inadequate treatment methods and patients who are neglecting treatment.

Signs and symptoms

What are the signs and symptoms of MDR TB (multiple drug resistant) ?

The most obvious signs and symptoms of MDR are of course the TB patient's health condition that does not improve and can even get worse, even after undergoing antituberculosis treatment.

Another possibility that you have drug-resistant TB is when the TB disease recurs some time after you don't feel the typical symptoms of TB.

MDR tuberculosis symptoms are more or less the same as tuberculosis patients in general, are:

• Cough won't heal
• Tiring easily and body weakness
• Bleeding cough
• No appetite
• Have a low-grade fever
• Weight loss drastically
• Shortness of breath and pain in the chest
• Night sweats

Cause

What causes MDR TB?

Today, more and more bacteria are resistant or resistant to first-line TB drugs. Basically, there are two things that are common causes of MDR TB, namely:

Inappropriate treatment

According to pulmonary specialist Erlina Burhan, who was met at a media discussion regarding MDR TB in May 2019, the first cause of MDR tuberculosis was the inadequate use of TB drugs by both the medical team and the patient.

Doctors or health workers cannot provide guidance, information on dosage and duration of treatment properly to patients.

Erlina also revealed that in the first-line TB treatment, patients must finish TB medication according to the prescribed dosage and schedule. If you are negligent or lack discipline in taking medication according to the rules, the patient is more at risk of experiencing drug resistance effects.

In addition, failure of TB treatment can also occur because patients find it difficult to get medicines. This is because anti-tuberculosis drugs are not always available in all regions in Indonesia.

Drug resistance properties of bacteria

Negligence of treatment is actually an external factor that causes the bacteria that cause tuberculosis, namely Mycobacterium tuberculosis (MTB) become resistant to TB drugs.

There are also internal factors in the form of the nature of the bacteria itself. Some MTB bacteria can have genetic traits (genotypes) that are resistant to certain antibiotics. This means that antibiotic resistance can also be a natural or congenital trait of the tuberculosis bacteria.

The chance for bacterial resistance will also increase if the amount of MTB in the body is very large. This means that more and more bacteria are resistant to different types of antibiotics. This is why, the duration of MDR TB treatment can last longer than it should be.

Risk factors

What factors can increase a person's risk of developing MDR TB?

MDR tuberculosis is a condition that can occur in almost every tuberculosis patient. However, there are several factors that put a person at an increased risk of developing resistance to anti-tuberculosis drugs.

It is important for you to know that having one or more risk factors does not necessarily mean that you have MDR TB disease. Risk factors are just a set of conditions that can increase your chances of developing a certain health condition.

The following are risk factors that can trigger MDR TB:

1. Patients with active pulmonary tuberculosis do not spend the drug

Some patients feel better after taking the drug for a certain period of time, then just stop the treatment before the drug runs out. This condition is one of the factors that makes a person more at risk of developing MDR TB.

2. Patients with active pulmonary tuberculosis do not take medication routinely

Apart from not finishing the drug, there are also some patients who may not take the medicine according to the doctor's recommendations and dosage. In other words, the patient tries to adjust the dosage according to his own accord.

The combination of anti-tuberculosis drugs that have been given by the doctor is of course already adapted to the patient's health condition. If these doses are not followed properly, the patient is likely to develop TB drug resistance.

3. Patients who do not take the whole drug

Another condition that can trigger MDR is not taking all of the drugs that are given. TB treatment is a combination of various drugs.

Forgetting to take certain drugs or even consuming only a few types, MDR TB has the potential to occur.

4. Live or be in an area with a high incidence of drug-resistant TB

Another thing that can cause MDR TB is living or working in areas with high cases of drug-resistant TB. The areas in question can be in the form of shelters, orphanages, health service centers and prisons.

These conditions increase the potential for transmission of drug-resistant tuberculosis bacteria to healthy people.

5. Make close contact with people with TB drug resistance

Transmission of drug-resistant tuberculosis bacteria can also occur even if you have never had TB before. This TB transmission can take place when you interact closely with people who have MDR TB.

Even so, MDR tuberculosis is a condition that can be overcome by handling and controlling the right risk factors.

Diagnosis

How do doctors diagnose this disease?

Some of the ways to diagnose MDR tuberculosis are with special laboratory tests. The doctor will perform molecular engineering tests, such as the Xpert MTB / RIF or also known as the Molecular Rapid Test (TCM).

TCM is done to detect germs Mycobacterium tuberculosis molecularly as well as determine whether there is resistance to certain types of antituberculosis drugs. The results of the examination with TCM can be obtained in a matter of hours. The level of accuracy is high enough, so that drug resistance conditions can be detected immediately.

In addition, doctors can also check for TB by analyzing samples of your body fluids, for example blood or sputum.

Treatment

What are the treatments for MDR TB?

MDR is a condition that can be cured. If the chance of cure for a typical TB patient is 90% when completing follow-up treatment, the bone for a drug-resistant TB patient to recover is 50%.

However, the treatment time is longer than that of normal tuberculosis because the tuberculosis bacteria in the patient's body are immune, evolved, and difficult to control.

MDR TB treatment will usually use second-line anti-tuberculosis (OAT) drugs. Common second-line anti-TB drugs, such as ciprofloxacin , ofloxacin, fluoroquinolone (levofloxacin), as well as injection drugs such as amikacin and kanamycin.

In addition, the following are specific treatment rules that are carried out to treat MDR tuberculosis:

1. The dosage of treatment varies, depending on the symptoms and where the TB bacteria are attacking.
2. The number and variants of the drug more.
3. Treatment time is longer, generally around 12-20 months.
4. Patients should receive drug injections 5 days a week for the first 8 months.
5. Implementing a healthy lifestyle, such as:
   • Do not smoke
   • Eating healthy food for tuberculosis sufferers
   • Keeping the house clean
   • Open the air vent every morning to get enough sunlight

MDR TB treatment must be intensive and isolated

In the book Tuberculosis written by a doctor named Diane Yancey, the top priority for treating drug-resistant TB patients is to get treatment as soon as possible under the supervision of a more experienced doctor. To be effective, doctors determine specific doses for each type of antituberculosis drug.

The patient's condition also needs to be closely monitored by medical personnel. Therefore, you will need to undergo intensive treatment at a health facility.

Meanwhile, if the patient is resistant to all anti-tuberculosis drugs or has serious organ damage to the development of life-threatening diseases, the doctor is most likely to perform a surgical procedure.

MDR TB can also lead to serious resistance. In more severe conditions, people with MDR TB can even develop resistance to second-line treatment. This condition is also known as XDR TB (Extensively drug-resistant / XDR tuberculosis).

MDR TB treatment side effects

Because the number of drugs is greater and more diverse, MDR TB treatment can provide more severe side effects of TB drugs than ordinary active TB treatment.

Some of the side effects of MDR tuberculosis treatment are:

• Nausea
• Gag
• Experiencing indigestion
• Hypothyroidism (thyroid hormone deficiency)
• Seizures to epilepsy
• Peripheral neuropathy (damage to the peripheral nervous system)
• Hepatitis

Prevention

How to prevent MDR TB?

Although dangerous, MDR TB is a preventable condition. The goal of preventing MDR TB is to avoid the transmission of TB bacteria that are already resistant to drugs, and reduce the risk of developing MDR tuberculosis into XDR TB.

Here are some ways to prevent TB drug resistance:

1. Take medication according to a doctor's prescription

The main prevention of MDR TB is to take medication according to a doctor's prescription and recommendation. Patients should not stop medication before the drug is finished, do not skip doses, or adjust the dosage according to their own preferences.

If a TB patient will be traveling to a distant place, the patient must first consult a doctor to ensure that he has sufficient supplies of medicine while traveling.

Doctors and the medical team will help prevent drug resistance by providing education about how to take TB medicine properly. In addition, the medical team must also ensure that they have clearly informed patients about the treatment procedures so that there are no misunderstandings.

2. Avoiding crowded, crowded, and crowded areas

Another way that can be done to prevent MDR tuberculosis is to avoid full and closed places. Especially if there are people with MDR TB in that place. Some of these places include hospitals, health centers, prisons, shelters, or nursing homes.

If you work in a hospital or other health center, you should regularly perform infection control checks or controls. You can also think of the best way to socialize MDR TB to people around you, especially those with risk factors for this disease.

3. Vaccination for tuberculosis

MDR TB is a condition that can be prevented from an early age with the TB vaccine. The vaccine is called Bacille Calmette-Guerin it is widely available in developing countries with high TB ​​cases. Not only MDR TB, BCG vaccination is the most effective TB prevention effort for all types of tuberculosis.