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Improving patient outcomes in TB
P171 The development of a UK National MDRTB service
  1. P D O Davies,
  2. D M Cullen
  1. TB Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK

Abstract

Introduction The low incidence in the UK means that few specialists treating tuberculosis have much experience of managing patients with MDRTB. To attempt to overcome this gap, the MDRTB Service was established at the Liverpool Heart and Chest Hospital in January 2008.

Method The service offers ready access to expert advice on the management of patients with MDRTB via an electronic virtual committee of TB experts. The advice given offers the likely best treatment for patients and by doing so prevents the emergence of Extreme drug resistant TB (XDRTB). The second function of the Service is to collect data on all MDRTB cases identified in the UK and record outcomes.

Results From 2008, the MDRTB Service has been approached for advice on 93 TB cases. Of these 70 were confirmed as MDR and 6 XDRTB whilst the remainder either could not be confirmed as MDR, were Isoniazid OR Rifampicin mono resistant or were more general requests for advice. The initial resistant patterns of 76 MDRTB cases showed resistance to Isoniazid and Rifampicin, 52% of the cases were resistant to Streptomycin, 41% to Ethambutol and 31% to Pryazinamide. Indeed 33% of cases were resistant to three Group 1 drugs and 29% to 4 drugs in this category. In the 6 XDR-TB patients, three were resistant to one group 2 drug only whilst the other three cases were resistant to more than one group 2 drug. All XDRTB cases were resistant to more than one group 3 drug, and 3 (50%) had more than one resistance in both drug groups. Patients of non-UK origin accounted for 86% of cases (male: 48%) of which 5 (8%) were XDR-TB, the rest MDR-TB. India (28%) and Sub Saharan Africa (26%) were the most prevalent countries of origin. 57% of patients had pulmonary disease, of which 82% were known to be sputum smear positive and therefore infectious. Three patients are known to have died and the rest are continuing on treatment.

Conclusion The MDRTB service is an important means of providing expert advice on management of these cases. Streptomycin resistance was present in the majority.

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