Understanding Multidrug-Resistant Tuberculosis (MDR-TB): Causes, Symptoms, and Treatment

Tuberculosis (TB) remains a significant global health challenge, but an even greater concern is Multidrug-Resistant Tuberculosis (MDR-TB). MDR-TB is a form of TB that does not respond to at least isoniazid (INH) and rifampicin (RIF), the two most potent first-line anti-TB drugs. This makes treatment more complex, expensive, and prolonged, increasing the risk of complications and transmission.

Causes of MDR-TB
MDR-TB primarily develops due to:

• Incomplete or improper TB treatment – When patients fail to complete their full course of TB medication, the bacteria may develop resistance.
• Incorrect prescription of TB drugs – Using the wrong drug combinations, incorrect dosages, or poor-quality medications can contribute to resistance.
• Person-to-person transmission – MDR-TB can spread through the air from an infected person to others, making early detection and treatment critical.

Symptoms of MDR-TB
The symptoms of MDR-TB are similar to drug-sensitive TB but may persist despite standard treatment. Common symptoms include:

• Persistent cough lasting more than three weeks, often with mucus or blood
• Fever and night sweats
• Unexplained weight loss
• Fatigue and weakness
• Chest pain and difficulty breathing

MDR-TB Can Develop at Any Site of Infection
While TB commonly affects the lungs, MDR-TB can also develop in other parts of the body, including the lymph nodes, spine, brain, kidneys, and joints . Extrapulmonary MDR-TB may cause symptoms depending on the infected site, such as severe back pain in spinal TB or swelling in lymph node TB.

Diagnosis of MDR-TB
To confirm MDR-TB, specialized laboratory tests such as *GeneXpert, Line Probe Assay (LPA), or Culture and Drug Sensitivity Testing (DST) – are performed to detect drug resistance. These tests help in selecting the appropriate treatment regimen.

Treatment of MDR-TB
MDR-TB treatment is longer and involves second-line antibiotics. The regimen includes:

• Bedaquiline, Delamanid, Levofloxacin, Moxifloxacin, or Linezolid, depending on drug susceptibility testing.
• Treatment duration ranges between 6 to 24 months.
• Strict adherence – to treatment is essential to prevent further resistance.
• Nutritional support and overall health management – play a crucial role in recovery.

Prevention of MDR-TB
Preventing MDR-TB involves:

• Completing the full course of TB treatment – as prescribed.
• Early diagnosis and prompt treatment – of drug-resistant cases.
• Infection control measures – like wearing masks, improving ventilation, and avoiding crowded places.
• BCG vaccination – in children to prevent severe forms of TB.

Conclusion
MDR-TB is a serious public health threat, but early diagnosis and proper treatment can help control its spread. Awareness, adherence to medication, and preventive measures are key in the fight against MDR-TB.

For expert consultation on TB and infectious diseases, visit Dr. Chhavi Gupta, MBBS, MD, DM (AIIMS, New Delhi), Senior Consultant in Infectious Diseases at Yashoda Super Speciality Hospital, Kaushambi.