Professional Documents
Culture Documents
Dr.T.V.Rao MD
A post graduate students question? What are the newer/emerging methods in Diagnosis of
MDR TB?
The question Answered with emerging technologies in mind by Dr.T.V.Rao MD
The Professionals and public should understand the definitions before they define the patients to be
suffering with MDR TB, when the patients failed to respond to the DOTS regime or taken the
empirical therapeutic regimes without much improvement
What is multidrug-resistant tuberculosis (MDR TB)?
Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and
rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease.
An estimated 480 000 people developed MDR-TB in 2014 and 190 000 people died as a result of it
WHO RECOMMENDS A NEW TEST - In May 2016, WHO issued new recommendations on the use
of a rapid diagnostic test a line probe assay to detect resistance to second-line anti-TB drugs (SLLPA).
WHO recommends this rapid diagnostic test for identifying those MDR- or rifampicin-resistant TB
patients who can be placed on the shorter MDR-TB regimen? The results of this test will also be
critical in placing patients on targeted conventional MDR-TB regimens with improved outcomes.
The SL-LPA produces results in just 24-48 hours, a vast improvement over the 3 months or longer
currently required. It allows quick triage of confirmed rifampicin-resistant or MDR-TB patients into
either the shorter MDR-TB regimen or the conventional longer regimen. WHY IT IS IMPORTANT Excluding second-line drug resistance a critical prerequisite for identifying patients who can be
placed on the shorter MDR-TB regimen.
These recommendations apply to the use of SL-LPA for the direct testing of sputum specimens as
well as indirect testing on culture isolates from rifampicin-resistant or MDR-TB patients, including
adults and children (irrespective of the smear status).
WHAT ARE ADVANTAGES OF THE NEWER METHODS WHAT TO DO AND NOT TO DO Detection of any second-line resistance by the SL-LPA means that MDR-TB patients should not be
enrolled on the shorter regimen (RNTCP) as this could jeopardise their treatment outcome and fuel
the development of XDR-TB. Patients detected with XDR-TB by the SL-LPA should also not be
enrolled on the shorter regimen but require carefully designed individual regimens to optimise their
chances of success