Multi drug Resistant Tuberculosis

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Multi drug Resistant Tuberculosis
National Tuberculosis Control Programme
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Multi drug Resistant Tuberculosis
MDR-TB, defined as resistance to the two most
important drugs, isoniazid (INH) and rifampicin
(RMP), is a potential threat to tuberculosis
control. Patients infected with strains resistant
to multiple drugs are extremely difficult to
cure, and the necessary treatment is much more
toxic and expensive.
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Drug resistance survey, Egypt (Pilot phase March
2000) (Extension phase March 2001)
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Drug resistance survey, Egypt

• Technical Steps
• At the Peripheral lab.
• 3 samples are taken from each patient.
• Prepare and examine 2 samples after straining
  with Z.N.
• The samples should be identified on the container
  as well as the cover and the code number of the
  patient is written on the containers.
• Code number governorate/ Chest clinic /No. on
  the special register of the survey.
• 2 samples from each positive case are sent to the
  intermediate lab with the questionnaire and
  special request form for culture.

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Drug resistance survey, Egypt

• At the Intermediate lab.
• A Z.N film from each sputum sample is examined
• One of sample is kept in the refrigerator and the
  second one is treated for culture on Lowenstein
  Jensen media and stone brink media.
• Positive cultures are sent to the C.L in ice box
  with the questionnaire and request for
  sensitivity test.

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Drug resistance survey, Egypt

• At the Central Lab
• Questionnaire is checked for the previous items.
• All the samples are registered in the Lab.
  register serially.
• Identification of the isolate is done using
  niacin test by strips and catalase test.
• Sensitivity tests is done by proportional method
• External quality control, all resistant strains
  and percentage of sensitive strains (10-15) are
  sent to the SRL.

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Drug resistance survey, Egypt (Pilot phase March
2000)

• WHO Recommended methodology
• Duration survey March 2000-July 2000
• Sample site Chest Clinics Cairo and Giza
• Validation patient category questionnaire
  (before start treatment)
• Culture Identification Susceptibility
• Quality control with international reference lab

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Results table -1-
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Results table -2-
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Drug resistance survey, Egypt (Extension phase
March 2001)
Aim This study aims at assessing the magnitude
of Multi Drug Resistant(MDR) Problem as a step to
put a strategy to overcome this problem
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Drug resistance survey, Egypt (Extension phase
March 2001)

• Objectives
• Identification of the prevalent resistant types
  of bacilli.
• Epidemiological features of MDR cases.
• To update the intermediate lab.Capabilities both
  equipment and personnel to be able to identify
  strains

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Drug resistance survey, Egypt (Extension phase
March 2001)

• Methodology
• 18 governorates have been selected on basis of
  number of new smear ve cases attending the
  clinics en each governorates(the number of
  attendants should not be les than 100
  patients/year)
• It expected that the Central Lab.to handle
  1500-1800 sensitivity tests during 12months of
  continuous work
• The first 100 new smear ve case in each
  governorate will be enrolled in the study.

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Drug resistance survey, Egypt (Extension phase
March 2001)
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Drug resistance survey, Egypt (Extension phase
March 2001)
New Cases
Old Cases
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New Cases
Total Number Tested 389 Total Sensitivity
286 73.5 Resistance to one drug
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New Cases
Multiple drug Resistance
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Chronic Cases
Total Number Tested 149 Total Sensitivity
41 27.5 Resistance to one drug
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Old Cases
Multiple drug Resistance
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Thank You