World Health Organization : Year 1996 ; World Health Organization, Tuberculosis, No. 96.210: Guidelines on the Management of Drug-Resistant Tuberculosis

By John Crofton

Book Id: WPLBN0000141007
Format Type: PDF eBook
File Size: 1.3 MB
Reproduction Date: 2005

Title:	World Health Organization : Year 1996 ; World Health Organization, Tuberculosis, No. 96.210: Guidelines on the Management of Drug-Resistant Tuberculosis
Author:	John Crofton
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Crofton, J. (n.d.). World Health Organization : Year 1996 ; World Health Organization, Tuberculosis, No. 96.210. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
FOREWORD 1. About one third of the world's population is infected by Mycobucterium tuberculosis. Worldwide in 1995 there were estimated about nine million new cases of tuberculosis with three million deaths. M Tuberculosis kills more people than any other single infectious agents. Deaths from TB comprise 25% of all avoidable deaths in developing countries. 95% of TB cases and 98% of TB deaths are in developing countries, 75% of these cases are in the economically productive age group (15 - 50). 2. As a consequence, the world is facing a much more serious situation in the twenty-first century than that of the mid-1950s. Due to demographic factors, socio-economic trends, neglected TB control in many countries, and in addition, the HIV epidemic, there are many more smear positive pulmonary TB cases, often undiagnosed andlor uneeated. When TB cases are treated, poor drug rescripti ion and poor case management are creating more TB patients excreting resistant tubercle bacilli. 3. In 1991, the World Health Assembly adopted Resolution WHO 44.8, recognizing eflective case management as the central intervention for tuberculosis control': and recommending the strengthening of national tuberculosis programmes by introducing short course chemotherapy and improving the treatment management system. Since 1992, the WHO Global Tuberculosis Programme has developed a new strategy, to meet the needs of global tuberculosis control.

Table of Contents
CONTENTS FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1 . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.1 Defimbons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.2 How is multidrug resistant (MDR) tuberculosis produced? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.3 Magnitude of the problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.4 How to prevent MDR tuberculosis? . . . . . . . . . . . . . . . . . . . . . 9 2 . BASIC PRINCIPLES FOR MANAGEMENT OF MDR TUBERCULOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 2.1 Specialized unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.2 Designing an appropriate regimen . . . . . . . . . . . . . . . . . . . . . . 11 2.3 Reliable susceptibility testing . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 Reliable drug supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5 Priority is prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.6 Using WHO standardized regimens for new cases and retreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.7 MDR tuberculosis as a consequence of poor treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.8 Long-term involvement of staff and financial resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3 . ASSESSING THE INDIVIDUAL CASE OF APPARENT MDR TUBERCULOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.1 Some provisos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.2 Collecting carefully the data concerning the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.3 Considering the criteria of failure of the retreatment regimen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.4 Interpreting the data for an individual patient . . . . . . . . . . . . . . 17 4 . AVAKABLE DRUGS FOR MDR TUBERCULOSIS . . . . . . . . . . . . 18 4.1 Essential antituberculosis drugs . . . . . . . . . . . . . . . . . . . . . . . . 18 4.2 Second-line antituberculosis drugs . . . . . . . . . . . . . . . . . . . . . . 19 4.3 Cross-resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 4.4 Classification of antituberculosis drugs for treatment of MDR tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . 21