In settings with a high prevalence of resistance, or in patients originating from such regions or with assumed drug resistance, it is necessary to strictly isolate patients and to treat them with four or five drugs until the results of drug susceptibility testing are available 24, 59. They reported a cure rate of 41.6% (n=84) and concluded that the additional immunotherapy with M. vaccae improves the cure rate of MDR-TB patients, although they stressed the need for a randomised clinical trial. These standards include taking into account and implementing nationally agreed guidelines. Cost savings of US$1,788 and US$2,215 per patient treated with DOT compared to conventional treatment were found. Perhaps the best scenario would be to run it at a loss as academic research perhaps involving students for higher degrees and then present the results of a pilot study to then try and gain some central funding to pursue the project on a wider scale. Here MDR-TB emerges mainly due to clinical complications and not due to programmatic inadequacies; 3) In countries with inappropriate TB programmes, which are already purchasing and using second-line drugs.
Publication No. It is believed that the rate of initial drug resistance reflects the quality and efficacy of treatment programmes, and that a high rate of initial resistance suggests a poor treatment programme. 2. 50 report that, in some regions, up to 75% of TB patients are HIV-positive. Stopping Tuberculosis in England Department of Health 2004. 11th Feb 2020 Nursing Essay Reference this ... NICE guidelines 2006 Clinical guideline 33 Tuberculosis Clinical diagnosis and management of tuberculosis, and measures for its prevention and control.
Study for free with our range of nursing lectures! However, these approaches are highly controversial and results of further clinical trials are needed before they might be introduced into the treatment of MDR-TB. Additionally, there might be shared risk factors between HIV infection and resistant TB (e.g. We do not capture any email address. In patients with drug resistance, the essential principle is to select at least two, preferably three, new drugs to which a recent isolate demonstrates in vitro sensitivity and which the patient has not received before. Such tests should be inexpensive and easy to perform without specialised equipment. Owing to a weakened immune defence, people infected with both M. tuberculosis and HIV are at greater risk of developing TB. WHO/CDS/TB/2000.278, Guidelines for surveillance of drug resistance in tuberculosis (1994). European Respiratory Society442 Glossop RoadSheffield S10 2PXUnited KingdomTel: +44 114 2672860Email: journals@ersnet.org, Print ISSN: 0903-1936 “Multidrug resistance” (MDR-TB) is a subgroup of polyresistance, in which there is resistance to at least rifampicin and isoniazid, the two most effective drugs against M. tuberculosis 3. In most cases, especially where there is existing resistance to more than one drug, resistance develops due to insufficient treatment leading to selection of spontaneously resistant strains. In the late 1980s and early 1990s, the MDR-TB epidemic in New York City, NY, USA, was caused mainly by severe underfinancing and thus understaffing of the TB control services, together with an increase in poverty and homelessness as well as an escalating rate of HIV infection 16, 17, 37. 33 found a high rate of infection with Beijing strains (70.8%) associated with high rates of MDR-TB (60.9%) in prisons in Azerbaijan (n=65). Nursing Essay Table 2⇓ summarises the results of four studies which investigated the treatment outcome of patients with MDR-TB who received second-line drugs on the basis of susceptibility testing. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the UKDiss.com website then please: Our academic writing and marking services can help you! This requires functioning tuberculosis control programmes (directly observed treatment short course), and, in some high prevalence countries, the introduction of second-line drugs on the basis of appropriate susceptibility testing (directly observed treatment short course-Plus). Citation: Rudgard WE, Evans CA, Sweeney S, Wingfield T, Lönnroth K, Barreira D, et al. Prevention: Preventive measures are required to protect NHPs and personnel who come into contact with NHPs that may harbor Mycobacterium tuberculosis complex (MTC - M. tuberculosis, M. bovis and M. africanum). Furthermore, it should be taken into consideration that the results come mainly from developed countries with good TB control programmes.
They reasoned that this was due to the limited number of suppliers and the lack of large-scale tenders. In countries with unstable TB control programmes, treatment regimens should use rifampicin only in the form of combined tablets of proven bioavailability to avoid monotherapy and to control the sale of anti-TB drugs on the private market 87. Considering the extent of drug resistance, three definitions are crucial for the management of patients 3: “monoresistance” is defined as resistance to one of the five first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin), whereas “polyresistance” is resistance of M. tuberculosis to two or more of the first-line drugs. Examples of such programmes are those of Chile, China (Beijing), Cuba and Uruguay, achieving cure rates of approximately or >80% and reporting mean MDR-TB rates of <1% in surveys 1. In order to cope with the problems caused by the development of drug resistance, other agents effective against M. tuberculosis were searched for and discovered (e.g. Some will be more directly involved than others and the degree of involvement will alter as the programme progresses. Bacteriological cure rates of >90% have been achieved in experienced centres after surgery and in combination with adequate chemotherapy (table 3⇓) 64–67. There are about 7000 cases of TB annually in the UK mostly in the large cities especially London (Health Protection Agency figures). All work is written to order. In poorly functioning TB control programmes, which result in an increasing number of TB patients and treatment failure, resistance is often caused by inadequate treatment regimens, insufficient patient adherence, and uncontrolled distribution and trade of drugs, as well as lack of availability and poor quality of anti-TB drugs. In summary, the sputum conversion rate in these studies ranged 51–95% and the treatment success rate 44–77% and the reported mortality ranged 0–37%. The later involves knowledge, changing attitudes and behaviour (Donaldson, 2003). The majority of TB cases remain treatable (cure rate >85%) under standard short-course chemotherapy using cheap and safe first-line drugs 34. Goble et al. Forty-two patients were included in the study. In table 1⇓, different treatment options, depending on the underlying resistance patterns, are shown. Second-line anti-TB drugs are generally considered to be less effective than first-line drugs and show a greater frequency of adverse reactions, and are, therefore, less well-tolerated 3, 57, increasing morbidity and cost 58. HIV infection is the strongest factor in developing active TB and advanced immunosuppression may also lead to increased reinfection.
The latest study, by Tahaoglu et al. Inadequate TB treatment results in treatment failure and development of acquired drug resistance. Disclaimer: This work has been submitted by a student. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. An estimated one quarter of persons worldwide are infected with Mycobacterium tuberculosis. Conversely, high rates of resistance tend to be associated with low treatment success. 5⇓).
In some laboratory experiments, resistant strains were less viable than sensitive ones in vitro, and often (though not always) less virulent in guinea pigs 1, 29, 30. VAT Registration No: 842417633. Multidrug-resistant tuberculosis is increasing, at least in some regions of the world, and may pose a serious threat globally. Estonia) could save up to 57.5% of their overall budget for TB control 84. The Health Belief Model (Becker, 1974) explains people will weigh up the benefits and risks of making a change and the Theory of Reasoned Action (Ajzen 1980) adds in the influences of family and friends. This situation is worsened by the increase in resistant TB (and MDR-TB) due to inadequate TB treatment 35. The basis of preventing and containing the further spread of MDR-TB is, besides poverty reduction, the expansion and application of the directly observed treatment (DOT) short-course (DOTS) strategy with all of its five constituent elements: 1) Political commitment.
In a recent study, the FASTPlaqueTB-RIFTM Rapid test (Biotech Laboratories Ltd, Ipswich, UK) has been shown to have an overall accuracy of 98% and the results are available after 48 h from M. tuberculosis cultures 55, 56. Treatment outcome of multidrug-resistant tuberculosis with second-line drugs#. The cost effectiveness of DOT for MDR-TB was demonstrated in an assessment between the USA and South Africa. Health Education Journal 44:167-8, Townsend P Phillimore P Beattie A 1987 Deprivation and health: inequality and the North. The tuberculosis prevention strategy basically consists of two crucial parts: First strategy to prevent tuberculosis is to stop the transmission the TB bacteria from one person to another and this can easily be done by identifying the person with active tuberculosis … Copyright © 2005 International Society for Infectious Diseases. In addition, a close link between the public health level and the medical as well as the research communities is required.
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