The quality of a tuberculosis (TB) control program can be judged by its rate of MDR TB. MDR TB (TB caused by M. tuberculosis isolates resistant to at least isoniazid and rifampin) is ubiquitous and man-made. The development of drug-resistant bacilli is always a consequence of human error and may result from a number of factors. Clinicians inexperienced in the treatment of TB may prescribe inadequate regimens for patients not known to harbor initially resistant organisms or may fail to recognize the manifestations of drug resistance as it develops. Programmatic failures may result in an insufficient or erratic supply of antituberculosis drugs, or poor drug quality may affect bioavailability and lead to a reduction in drug efficacy. Poor case management, such as permitting patients to self-administer or tailor their own regimens, may also induce drug resistance. MDR TB can be controlled by the universal implementation of the WHO TB control strategy (DOTS), which emphasizes use of standardized treatment regimens, an uninterrupted supply of high-quality drugs, and directly-observed treatment. Given the high morbidity and mortality associated with MDR TB, as well as the high cost of treating MDR TB patients, it is essential that TB control programs employ these measures to prevent MDR TB.
Learning Objectives: Participants will be able to: 1) Understand the factors that create MDR TB. 2) Understand measures to prevent the generation and transmission of MDR TB.
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