TB Facts for Health Care Workers
Multidrug-Resistant Tuberculosis (MDR TB)
An extremely serious aspect of the TB problem in the United States is
MDR TB (i.e., TB caused by organisms resistant to at least isoniazid
and rifampin, the two most important anti-TB drugs). MDR TB can
usually be prevented by initially treating TB patients with four
drugs and by administering TB medications on a directly observed
basis. Persons at high risk for MDR TB include persons who have
been recently exposed to MDR TB, especially if they are immunocompromised;
TB patients who failed to take medications as prescribed; TB patients
who were prescribed an ineffective treatment regimen; and persons
previously treated for TB.
MDR TB presents difficult treatment problems. Treatment must be
individualized and based on the patientís medication history and
drug susceptibility study results. Clinicians who are not expert
with the management of patients with MDR TB disease or with patients
infected with multidrug-resistant organisms should seek expert consultation.
Contact your state health department TB program or your Regional
Training and Medical
(RTMCC). Contact information for the RTMCCs
is located at the back of this booklet.
The risk for progression to TB disease should be considered before
recommending treatment for LTBI. Alternative regimens should consist
of drugs to which the infecting organism has demonstrated susceptibility.
A potential regimen includes daily fluoroquinolone, an antibiotic,
for 6-12 months.
Contacts may be treated for 6 months or observed without treatment.
Immunocompromised contacts (e.g., persons who are HIV infected)
should be treated for 12 months. All persons with suspected MDR
LTBI should be followed for 2 years regardless of the treatment