How is multi-drug resistant TB treated?
Jul 24, 2007
<b>Dear doctor, my sister who has HIV but has not yet started on ARVs because her CD4 is still high, was diagnosed to be having TB six months ago. She was put on TB drugs for eight months. She took the drugs for one month, improved and even put on weight. Unfortunately, she stopped taking the drugs
How is multi-drug resistant TB treated?
Dear doctor, my sister who has HIV but has not yet started on ARVs because her CD4 is still high, was diagnosed to be having TB six months ago. She was put on TB drugs for eight months. She took the drugs for one month, improved and even put on weight. Unfortunately, she stopped taking the drugs after seeing a slight improvement. The cough came back and she was put back on the drugs, but she has not improved. The doctors say they tested her sputum and found she has multi-drug-resistant TB. What is this multi-drug resistant TB and how is it treated?
Sauda
Dear Sauda, TB is a very big challenge for all of us who are involved in HIV/AIDS care. It must, therefore, always be suspected in all HIV+ individuals. When we decide to treat it, we must do so whole-heartedly. Normally, a person with TB starts to feel better a few weeks after starting on the TB drugs. He or she must, however, continue and finish the eight-month course of treatment prescribed. The patient must be monitored by doing sputum examination, for instance, after two months of treatment and at the end to see if there are no TB bacteria in the sputum.
If a person continues to have TB bacteria in his or her sputum when he or she is on treatment or at the end, it means the TB is resistant to the drugs being used.
Multi drug- resistant TB refers to TB, which is resistant to two or more of the standard drugs used. Normally, we use four drugs (Rifampicin, Isoniazid, Ethambutal and Pyrazinamide). When TB is resistant to two or more of the above drugs; usually Rifampicin and Isoniazid, then it is described as being multi-drug resistant TB (MDR-TB).A culture and sensitivity test should be done so that new drugs to which the TB is sensitive are identified and used in treating her and she must adhere to them so that these too do not fail.
Other drugs, which can be used in treating MDR-TB include Ofloxacin, Streptomycin and Ethionamide. To these, Ethambutal and Pyrazinamide must be added and she must take them longer than the eight standard months of TB treatment as advised by her doctor.
Lastly, your sister should be on ARVs even when her CD4 is still high. When someone starts having what are called AIDS defining illnesses like TB, they should be put on ARVS regardless of their CD4 count.
Can I stop taking septrin since I am on ARVs?
Dear doctor, I have been taking septrin daily for the last four years since I was diagnosed with HIV/AIDS. Two years ago, my CD4 count, which had been high for two years, dropped to 160 cells/ml and I was advised to start taking ARVs. I was put on Combivar and Nevirapine and my CD4 is now consistently over 600 cells/ml for over six months. Do I need to continue swallowing the septrin now?
Alison
Dear Alison, the decision whether to continue or stop taking septrin should be reached at after you and your doctor, who prescribed them for you, have had a discussion and he or she has assessed your present situation. I have not yet come across a study done to assess the safety of discontinuing septrin when ones’ CD4 count is above 200-250 cells per ml (when it is recommended for one to start taking ARVs) so I cannot authoritatively give you advice based on evidence at the moment.
Sometimes patients have been advised to take septrin on alternative days rather than daily, though this often confuses some patients who are on ARVs and septrin. They forget and swallow ARVs on alternative days instead of septrin.
Septrin taken on alternative days is thought to be as effective so long as one is consistent.
Septrin helps prevent common infections like respiratory infection, diarrhoea and malaria to people living with HIV/AIDS on septrin. It is part of the basic care package together with safe water vessels, insecticide-treated mosquito nets and nutritional rehabilitation; given to people living with HIV/AIDS. All drugs, septrin inclusive, should be used rationally. So, if there is no indication for their use, your doctor will advise you accordingly.
Send your question on HIV to Health Editor,
The New Vision. P. O. Box 9815, Kampala or
health&beauty@ newvision.co.ug
Dear doctor, my sister who has HIV but has not yet started on ARVs because her CD4 is still high, was diagnosed to be having TB six months ago. She was put on TB drugs for eight months. She took the drugs for one month, improved and even put on weight. Unfortunately, she stopped taking the drugs after seeing a slight improvement. The cough came back and she was put back on the drugs, but she has not improved. The doctors say they tested her sputum and found she has multi-drug-resistant TB. What is this multi-drug resistant TB and how is it treated?
Sauda
Dear Sauda, TB is a very big challenge for all of us who are involved in HIV/AIDS care. It must, therefore, always be suspected in all HIV+ individuals. When we decide to treat it, we must do so whole-heartedly. Normally, a person with TB starts to feel better a few weeks after starting on the TB drugs. He or she must, however, continue and finish the eight-month course of treatment prescribed. The patient must be monitored by doing sputum examination, for instance, after two months of treatment and at the end to see if there are no TB bacteria in the sputum.
If a person continues to have TB bacteria in his or her sputum when he or she is on treatment or at the end, it means the TB is resistant to the drugs being used.
Multi drug- resistant TB refers to TB, which is resistant to two or more of the standard drugs used. Normally, we use four drugs (Rifampicin, Isoniazid, Ethambutal and Pyrazinamide). When TB is resistant to two or more of the above drugs; usually Rifampicin and Isoniazid, then it is described as being multi-drug resistant TB (MDR-TB).A culture and sensitivity test should be done so that new drugs to which the TB is sensitive are identified and used in treating her and she must adhere to them so that these too do not fail.
Other drugs, which can be used in treating MDR-TB include Ofloxacin, Streptomycin and Ethionamide. To these, Ethambutal and Pyrazinamide must be added and she must take them longer than the eight standard months of TB treatment as advised by her doctor.
Lastly, your sister should be on ARVs even when her CD4 is still high. When someone starts having what are called AIDS defining illnesses like TB, they should be put on ARVS regardless of their CD4 count.
Can I stop taking septrin since I am on ARVs?
Dear doctor, I have been taking septrin daily for the last four years since I was diagnosed with HIV/AIDS. Two years ago, my CD4 count, which had been high for two years, dropped to 160 cells/ml and I was advised to start taking ARVs. I was put on Combivar and Nevirapine and my CD4 is now consistently over 600 cells/ml for over six months. Do I need to continue swallowing the septrin now?
Alison
Dear Alison, the decision whether to continue or stop taking septrin should be reached at after you and your doctor, who prescribed them for you, have had a discussion and he or she has assessed your present situation. I have not yet come across a study done to assess the safety of discontinuing septrin when ones’ CD4 count is above 200-250 cells per ml (when it is recommended for one to start taking ARVs) so I cannot authoritatively give you advice based on evidence at the moment.
Sometimes patients have been advised to take septrin on alternative days rather than daily, though this often confuses some patients who are on ARVs and septrin. They forget and swallow ARVs on alternative days instead of septrin.
Septrin taken on alternative days is thought to be as effective so long as one is consistent.
Septrin helps prevent common infections like respiratory infection, diarrhoea and malaria to people living with HIV/AIDS on septrin. It is part of the basic care package together with safe water vessels, insecticide-treated mosquito nets and nutritional rehabilitation; given to people living with HIV/AIDS. All drugs, septrin inclusive, should be used rationally. So, if there is no indication for their use, your doctor will advise you accordingly.
Send your question on HIV to Health Editor,
The New Vision. P. O. Box 9815, Kampala or
health&beauty@ newvision.co.ug