Managing multi-drug resistant tuberculosis

Background: Seventeen multi-drug resistant tuberculosis (MDR-TB) cases out of 163 drug-resistant TB cases (10%) were reported to Texas Department of State Health Services in 2005 and 2006. The societal costs of MDR-TB vary due to length of therapy and deaths during treatment (Average costs for treating MDR-TB have been quoted to be $100,000), hence a comprehensive approach of surveillance, diagnostic evaluation, clinical intervention and management of MDR-TB cases is imperative. Methods: It is critical that patients who have MDR-TB be treated to cure. The process of managing these patients requires not only understanding the epidemiology of the disease but also ensuring that the patient be placed on effective treatment regimen and is evaluated medically monthly. Directly observed therapy and assessment for adherence to treatment is essential. Surveillance and genotyping data were matched to examine clustering indicating recent transmission of MDR-TB. Results: Out of 17 MDR-TB cases, 1 extremely drug resistant (XDR) TB case was identified. Sixty-five percent of the MDR-TB cases were Hispanic white males, eighteen percent were Asians and six percent were African-Americans. Eighty-eight percent of the MDR-TB cases were foreign born, 23% had diabetes and 41% had excess alcohol as risk factors. Fifteen of the 17 MDR-TB cases were genotyped out of which sixty-six percent was clustered indicating recent transmission. Discussion: MDR-TB is complicated and expensive to manage. A systematic management system has been implemented by utilizing public health strategies that will prevent and control transmission of tuberculosis.