MDR tuberculosis

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What is MDR tuberculosis?

MDR tuberculosis is caused by mycobacteria that have become resistant to many drugs. The shortening MDR-TB comes from the English words multidrug-resistant tuberculosis. The main and most effective TB drugs, rifampicin and isoniazid, cannot be used to treat this type of TB.

If tuberculosis is also resistant to fluoroquinolones, it is called pre-XDR-tuberculosis.

XDR (extensively drug resistant)-tuberculosis, i.e., widely drug-resistant tuberculosis, is resistant to bedaquiline and/or linezolid in addition to the drugs mentioned above.

Where can I get MDR tuberculosis?

Tuberculosis is always transmitted the same way, through the air. Infection can be spread by a person suffering from MDR-TB.

MDR-TB is most common in countries with poor access to TB diagnostics (no skills or equipment) or drug treatment. Treatment practices may also be inadequate.

Sometimes, initially drug-sensitive tuberculosis develops resistance to rifampicin and isoniazid during treatment. This can happen if TB treatment is irregular or involves repeated or long breaks.

MDR-TB is found all over the world. Nearly half of those affected live in India, China and the Russian Federation. The number of MDR-TB cases is particularly high in the WHO European Region, mainly outside of EU / EEA countries.

In Finland drug-resistant tuberculosis is rare: a few cases of MDR-TB are diagnosed each year and there have been only single cases of pre-XDR and XDR-TB in the 2010s and 2020s.

How is MDR tuberculosis treated?

MDR-tuberculosis is treated with a combination of several drugs and the treatment lasts for a long time. Initially, 5-7 different drugs are needed, but later, once the treatment has started to work, the number of drugs can be reduced to 4-5.  The aim is always to find the most effective combination of drugs for each patient. The treating doctor is assisted by the national team of TB treatment experts who make a recommendation on the combination of drugs.

Treatment for MDR-TB may cause adverse effects, and the patient will be given information and instructions on self-monitoring. Adverse effects can be alleviated in many ways. Sometimes the medication that has caused serious harm has to be discontinued.

Treatment for MDR-TB usually lasts two years. Sometimes drug treatment alone is not sufficient and surgery is required for recovery.

Can MDR-TB be cured?

The only way to get better from MDR-TB is to commit to daily drug treatment. This is supported by a trained person who monitors the intake of TB medications and looks out for possible adverse effects.

The outcome of treatment for MDR-TB depends on many factors. The extent of the disease, the resistance of the TB strain, the age and other diseases of the patient, as well as how well the patient can tolerate TB medication all affect the outcome. Treatment for MDR-TB fails more often than treatment for common TB because the drugs are less effective and prolonged treatment is associated with a higher likelihood of adverse effects.

New, more effective drugs are needed to treat MDR-TB, and they are being developed worldwide.