RECENT ADVANCES IN MULTIDRUG RESISTANT TUBERCULOSIS AND

Abstract REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM: ROLE OF

No: AIN 49 CLINAL PHARMACIST , A PERSPECTIVE
Vismaya Annie Vinod* ,Ammu S, Shaiju S Dharan, Dr. Mathan S.
Ezhuthachan College of Pharmaceutical Sciences, Marayamuttom,
Neyyattinkara P.O, Thiruvananthapuram-695131
Corresponding author:annievinodvismaya@gmail.com
ABSTRACT REGIMENS RECCOMENDED BY WHO FOR THE TREATMENT
OF MDR-TB
TB is a communicable infectious disease caused by the bacillus Mycobacterium Drug susceptibility profile Initial phase(6 months) Continuation phase(12-18
tuberculosis and characterized by the formation of nodular lesions (tubercles) in the for essential drugs months)
and persists as a global public health problem of serious magnitude requiring urgent Not available Kanamycin Ethionamide
attention. Current global efforts to control TB have three distinct but overlapping Ethionamide Quinolone
dimensions: humanitarian, public health, and economic. The rntcp will be using a Quinolone Pyrazinamide/ethambutol
standardized treatment regimen (str), comprising of 6 drugs (kanamycin, ofloxacin, Pyrazinamide/ethambutol
ethionamide, pyrazinamide, ethambutol, and cycloserine) during 6–9 months of the
intensive phase and 4 drugs (ofloxacin, ethionamide, ethambutol, and cycloserine) Resistant to isonisid Streptomycin Ethionamide
during the 18 months of the continuation phase. All drugs should be given in a single and rifampicin Ethionamide Quinolone
daily dosage under directly observed treatment (dot) by a dot provider. Pyridoxine at a Quinoilone Pyrazinamide/ethambutol
dose of 100mgs should be administered to all patients on an RNTCP category IV Pyrazinamide/ethambutol
regimen. Pharmacists play a vital role in the management of patients with TB by Resistant to all 1injectable+quinolone+2 1quinolone+2 of these 3
providing their expertise within an interdisciplinary team approach to patient care. essential drugs of these 3 drugs:PAS,ethinamide,cycl
They can assess the appropriateness, efficacy, and safety of antituberculous therapy by drugs:PAS,ethionamide,c oserine
monitoring patients and ensuring medication adherence. ycloserine
INTRODUCTION Drug susceptibility profile Individually tailored Individually tailored
of reserve drugs available regimen according to regimen according to
Revised National Tuberculosis Control Program (RNTCP) is the state-run tuberculosis susceptibility pattern susceptibility pattern
(TB) control initiative of the Government of India. As per the National Strategic Plan
2012–17, the program has a vision of achieving a "TB free India", and aims to achieve DOSE RECOMMENDATIONS
Universal Access to TB control services. The program provides, various free of cost, drugs <45kg >45kg
quality tuberculosis diagnosis and treatment services across the country through the
government health system. It seeks to employ the WHO recommended tuberculosis Kanamycin 500 mg 750mg
control strategy, DOTS(Directly Observed Treatment, Short Course), to the Indian Ofloxacin 600mg 800mg
scenario.
Ethionamide 500mg 750mg
RNTCP AND DOTS THERAPY
Ethambutol 800mg 1000mg
RNTCP will be using a Standardised Treatment Regimen (Cat IV) for the treatment of
MDR-TB cases (and those with rifampicin resistance) under the programme. Cat IV Pyrazinamide 1250mg 1500mg
regimen comprises of 6 drugs- kanamycin, ofloxacin (levofloxacin) , ethionamide, Cycloserine 500mg 750mg
pyrazinamide, ethambutol and cycloserine during 6-9 months of the Intensive Phase
and 4 drugs- ofloxacin (levofloxacin), ethionamide, ethambutol and cycloserine during PAS 10mg 12mg
the 18 months of the Continuation Phase. p-aminosalicylic acid (PAS) is included in the
regimen as a substitute drug if any bactericidal drug (K, Ofl, Z and Eto) or 2
ROLE OF CLINICAL PHARMACIST
bacteriostatic (E and Cs) drugs are not tolerated. Pharmacists play a pivotal role in the management of patients with TB by providing
their expertise within an interdisciplinary team approach to patient care. They can
RNTCP CATEGORY IV REGIMEN: 6 (9) Km Ofx (Lvx) Eto Cs Z E / 18 Ofx (Lvx)Eto Cs E assess the appropriateness, efficacy, and safety of antituberculous therapy by
monitoring patients and ensuring medication adherence. They can educate patients and
Since the drugs used for the treatment of MDR-TB are known to produce adverse
clinicians about the expected therapy outcomes and the side effects as well as drug
effects, The pre-treatment evaluation will include the following:
interactions associated with antituberculous agents. Minor adverse events such as
Detailed history (including screening for mental illness, drug/alcohol abuse etc.),Weight, gastrointestinal disturbances are common in the first few weeks of therapy and usually
Height, Complete Blood Count, Blood sugar to screen for Diabetes Mellitus, Liver do not necessitate discontinuation of first-line agents. Patients may choose to take their
Function Tests,Blood Urea and S. Creatinine to assess the Kidney function, TSH levels medications with food, although absorption may be delayed. Other adverse events such
to assess the thyroid function,Urine examination – Routine and Microscopic,Pregnancy as drug-induced hepatitis, pyrazinamide-induced hyperuricemia, and ethambutol-
test (for all women in the child bearing age group), Chest X Ray induced optical neuritis are more serious, require further evaluation, and may
necessitate discontinuation of therapy. Pharmacists may recommend pyridoxine to
DOTS (directly observed treatment, short-course), is the name given to the World
decrease the risk of isoniazid-induced neuropathy. They should screen patients with
Health Organization recommended tuberculosis control strategy that combines five
comorbid conditions such as HIV infection for potential drug interactions, particularly
components:
those patients receiving rifamycins and protease inhibitors. Pharmacists can also
1. Government commitment (including both political will at all levels, and establishing educate patients and clinicians about the importance of adherence and DOT to ensure
a centralized and prioritized system of TB monitoring, recording and training) efficacy and minimize resistance. They should remain vigilant to avoid the addition of a
single agent to a failing regimen.
2. Case detection by sputum smear microscopy
Studies have shown better outcomes and substantially improved rates of treatment
3. Standardized treatment regimen directly observed by a healthcare worker or
completion when pharmacists are directly involved in the management of patients with
community health worker for at least the first two months
TB, including health care workers. Institutions should explore the possibility of adding
4. A regular drug supply a pharmacist to their TB management team.
5. A standardized recording and reporting system that allows assessment of treatment CHALLENGES AND FUTURE TARGETS
results Challenges are
(a) ensuring that existing staff, managerial and clinical, is competent to implement all
components of RNTCP including DOTS Plus activities
(b) ensuring that there is enough staff available at all times. Key strategies to reach the
goal are:
.
1. In-service training in DOTS-Plus districts for various categories of staff
2. In-service training for monitoring and supervision
BIBLIOGRAPHY
1. Central TB Division, Directorate General of Health Services, Ministry of Health &
Family Welfare. DOTS-Plus Guidelines 2017p. 1-46
2. Jagota P. Revised National Tuberculosis Control Programme, success story. Indian J
Tuberculosis. 2002;49:69–73.
3. Toman K. World Health Organization. 1979. Tuberculosis, chemotherapy
Presented at the international seminar held at pushpagiri college of pharmacy on 15th february 2018
TEMPLATE DESIGN © 2008

www.PosterPresentations.com