Extensively Drug Resistant Tuberculosis: An Upcoming Challenge To Face And Treat.

Abstract

Extensively  drug  resistant  tuberculosis ( XDR- TB)  has been  reported by  45 countries   worldwide  ,  to  World Health Organisation ( WHO ) . XDR-TB  is  a  uniformly  lethal  disease that has emerged in countries with limited resources and high prevalence of tuberculosis , mainly as a result of  previous inadequate or improper treatment and poor adherence by the patient to the treatment . It has been defined by WHO Global Task  Force  as – Mycobacterial  tuberculosis  infection that is resistant to isoniazid , rifampicin , any fluoroquinolone and  at least one  of the three  injectable  drugs i.e.  amikacin , kanamycin  and capreomycin . Patients co-infected with HIV were found to be at more risk to XDR- TB. An aggressive drug treatment regimens, as a part of comprehensive  therapeutic  approach  including  infection  control  measures,  along   with  DOTS – plus implemented by  WHO  are required that can cure many patients  with  XDR – TB , who are not infected  with HIV. Along  with  rapid recognition of cases and  prompt contact recognition , drug therapy includes as first line agents , ethambutol and pyrazinamide  for the entire duration of therapy . An injectable  agent  like kanamycin  in streptomycin resistant cases , amikacin in kanamycin and streptomycin resistant cases , capreomycin and vyomycin in cases of kanamycin or streptomycin resistant cases  should  be included , along with monitoring for ototoxicity  and nephrotoxicity .