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Drug-Resistant Tuberculosis: A Review of the GuidelinesBrett K; Dulong C; Severn MDrug-Resistant Tuberculosis: A Review of the Guidelines-/-CADTH Rapid Response Reports 2020[Mar]; ä (ä): äTuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis and is transmitted through the air by those who are infected with the bacteria (i.e., coughing). According to the World Health Organization (WHO), roughly a quarter of the world's population is infected with M. tuberculosis and may be at risk for developing the disease. TB typically affects the lungs of a person (i.e., pulmonary TB) but can also spread to other parts of the body (i.e., extrapulmonary TB). TB is prevalent in low and middle income countries, as the disease is associated with poverty, poor sanitation or hygiene practices and being easily transmissible from person to person. However, high income countries, including Canada, still report cases of TB and it is considered an important public health matter. According to the Public Health Agency of Canada (PHAC), Canada has one of the lowest rates of active TB disease in the world. However, annual rates of TB have remained the same in the country since the 1980's rather than steadily declining. In 2017, PHAC reported 1,796 cases of active TB in Canada with migrants and Indigenous peoples bearing the highest rates of active TB in the country and approximately 70% of cases being pulmonary TB.(,) Individuals with TB are categorized into latent TB infection (LTBI) and active TB disease.(,) LTBI refers to an individual who has the M. tuberculosis infection in which the bacteria are alive but are not currently causing active TB disease. Active TB disease occurs when the TB bacteria begins to multiply and the individual's immune system is compromised, leading to disease. Moreover, patients with active TB disease can have drug-resistant TB (DR-TB). DR-TB refers to cases of TB where the bacteria are resistant to one of the first-line therapies for TB (e.g., isoniazid). More specifically patients can be categorized as having multi-drug resistance (MDR-TB) when the bacteria are resistant to at least isoniazid and rifampicin, the two most commonly used drugs for TB treatment. They can also be categorized as extensively drug-resistant TB (XDR-TB) when the bacteria are resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs.(,) Patients with MDR-TB and XDR-TB have fewer treatment options. According to the WHO, there are approximately 490,000 cases of MDR-TB worldwide.(,) MDR-TB and XDR-TB cases are on this rise and may be due to mismanagement of treatment or person-to-person transmission, leading to higher drug resistance. Proper diagnosis and treatment regimens for DR-TB, MDR-TB and XDR-TB can help control drug-resistant cases.(,) There are numerous guidelines published on TB that may vary in quality and the topics covered, which may make it difficult for health care professionals to select the optimal care for patients with DR-TB. The purpose of this report is to review and critically appraise the evidence-based guidelines regarding DR-TB. This report is part of series of evidence reviews on TB guidelines and can serve as a guidance document to identify which guidelines include recommendations for DR-TB. This report does not cover LTBI and drug-susceptible TB, which can be found in separate reports.(-) This report focuses on strategies for the prevention, identification, and treatment of DR-TB. This report is a component of a larger CADTH Condition Level Review on TB. A condition level review is an assessment that incorporates all aspects of a condition, from prevention, detection, treatment, and management. For more information on CADTH's Condition Level Review of TB, please visit the project page (https://www.cadth.ca/tuberculosis).ä |
