Discuss about the Causes & Effects of MDR-TB for Tuberculosis and Resistance.
MDR-TB is the short form of Multi Drug Resistant TB. As the name suggests, MDR-TB is a specific condition where someone becomes resistant to TB drugs. There are basically two primary TB drugs. These are the isoniazid (INH), and the other one is rifampicin (RMP). When someone is said to be resistant to TB drugs, it means that these two drugs can no longer alleviate the conditions. There is always a strong assumption of drug resistance, especially where a person had a history of treatment failures or just a halted treatment.
Keywords: Tuberculosis, Resistance, MDR-TB, Isoniazid, Rifampicin
MDR-TB is a tuberculosis resistance conditions that develop as a high-level non-response to the two drugs, the isoniazid, and rifampicin. Currently, Tuberculosis (TB) is one of the major infectious which is causing the global mortality. Many believe that nonadherence to the treatment and is the main cause of MDR-TB. Despite that, there has never been a sound reason as to why patients result to nonadherence.
There are mainly three causes of MDR-TB. Some of these are the errors in the medical field, basic microbiology, and patient non-compliance (Günther et al., 2016). Fundamental microbiology is concerned more with microbiological adaptations. That is the evolving nature of the living organism. Gagneux, (2012) states that bacterial pathogens evolve in the human hosts and there is nothing that can prevent such development. However, people can correct the medical errors and encourage patient compliance to prevented the adaptation.
In medical science, pathogens acquire drug resistance from particular genetic mutations. This modification enables them to withstand the presence of their counterpart drugs. In social science, the failure to prescribe correct drug regimen to the patient, or their non-compliance with the required drug plan allows TB pathogens to acquire drug-resistant mutation (Thomas et al., 2016). Therefore, access to accurate public health services and effective chemotherapy is one paramount factor for the reduction of MDR-TB epidemics (Banin, Hughes & Kuipers, 2017).
Lack of awareness and proper TB treatment is a significant factor for the expansion of MDR-TB. This claim is evident in the wrong consumption of the accessible anti-TB drugs and DOTS (Directly Observed Treatment Short Course). The study of (Trauner, Borrell, Reither & Gagneux, 2014) discovered that limited knowledge of TB treatment chemotherapeutic procedures due to improper medical training. Studies show that this could also have had a great impact on the spread of MDR-TB because poorly trained health providers cause the wrong prescription.
Consumers non-compliance with TB drug treatment plan is another determinant to the expansion of MDR-TB cases. Medical noncompliance can also be blamed to patients’ the lack of awareness regarding TB disease. A study by (Desai, Jain, Solanki & Dikshit, 2014) discovered that lack of adequate patient counseling led to the lack of the understanding of the necessity to adhere to the medical plan. Also, another possible cause of patients’ noncompliance is the economic factors. For instance, (Thomas et al., 2016) found that despite the free anti-TB drugs from the government, some patients with pulmonary TB might face some financial problems paying for supplementary examinations. They might also be unable to pay for other drugs for dealing with severe TB drug side effects. Further, the TB-drugs regimen of the prolonged taking of multiple drugs proves difficult for some patients to adhere.
Furthermore, there are limited practical public health standards, if any, for managing those TB patients who have acquired the infection of MDR while still going through the regular anti-TB treatment (Thomas et al., 2016). There is a possibility of the spread of MDR-TB strain from the emerging MDR-TB patients. In case such a thing happens, it causes the health services to deal with a case of new TB patients coming with MDR-TB instead of the standard TB.
Managing MDR-TB is more involved than managing the regular TB. MDR-TB requires intravenous administration which is less efficient and more toxic when compared with the conventional TB drugs treatment. MDR-TB cases have high mortality, and treatment takes an extended period. As a result, patients and their families suffer loss of employment, social isolation, long-term psychological and socioeconomic effects.
Some employers are intolerant to low performance, sick leaves, and missed work days. As a result, they can choose to terminate the contract based on lack of substantial performance at work which creates a huge loss of income (Wingfield et al., 2016). If not terminating the contract, they may wait for the end of the tenure of the contract and refuse to renew it with the patient. Also, some choose to reduce the patient’s salary. On the other hand, some patients are so weak to continue working, or they may be unable to work due to the effects of MDR-TB drugs (Laurence, Griffiths & Vassall, 2015). Due to lack or minimized financial income, patients result to seeking financial support from family members or friends.
MDR-TB patients feel hopelessness and fearful. Sometimes, MDR-TB is even unavailable, and some patients cannot afford to pay. Patients also have a fear of death or affecting their family members with the disease (Khanal et al., 2017). Many patients also become distressed with the new style of living. MDR-TB treatment changes someone sleeping arrangements. Patients also eat alone, and they are not able to remain close to their friends or relatives. These outcomes make patients feel depressive and invaluable (Khanal et al., 2017). However, this only happens to some patients as others from understanding families do not experience isolation. In (Laurence, Griffiths & Vassall, 2015), the study finds that the economic effects of MDR-TB discussed above as causes of physiological effects such as stress and anxiety.
Every MDR-TB suffers an impact to his or her social life from the onset of diagnosis and in the endurance of the treatment (van Hoorn, Jaramillo, Collins, Gebhard & van den Hof, 2016). Patients change in the way they interact with other, the way they perceive themselves and the onset of the inability to stay contributing in usual social activities. Stigma also arises from misunderstanding and social disapproval of the patient’s characteristics and the beliefs and norms of the culture (Cremers et al., 2015). For instance, patients also suffer discrimination and from family and friends who think MDR-TB is contagious even while in the open air. Even after a determination that MDR-TB is non-infectious, family and friends still consider patients as unsafe.
Conclusion
MDR-TB has now become a global problem. Most notable instances are resulting from two cases. Either from the physician mistakes or lack of patient’s compliance with the susceptible TB treatment procedures. There is a great need to educate patients on the risk of non-compliance, and also implement effective methods of countering physician mistakes of the wrong prescription.
References
Gagneux, S. (2012). Host-pathogen coevolution in human tuberculosis. Philosophical Transactions of the Royal Society B: Biological Sciences, 367(1590), 850–859. https://doi.org/10.1098/rstb.2011.0316
Trauner, A., Borrell, S., Reither, K., & Gagneux, S. (2014). Evolution of Drug Resistance in Tuberculosis: Recent Progress and Implications for Diagnosis and Therapy. Drugs, 74(10), 1063–1072. https://doi.org/10.1007/s40265-014-0248-y
Jain, K., Desai, M., Solanki, R., & Dikshit, R. K. (2014). Treatment outcome of standardized regimen in patients with multidrug resistant tuberculosis. Journal of Pharmacology & Pharmacotherapeutics, 5(2), 145–149. https://doi.org/10.4103/0976-500X.130062
Wingfield, T., Tovar, M., Huff, D., Boccia, D., Montoya, R., & Ramos, E. et al. (2016). The economic effects of supporting tuberculosis-affected households in Peru. European Respiratory Journal, 48(5), 1396-1410. https://dx.doi.org/10.1183/13993003.00066-2016
Laurence, Y., Griffiths, U., & Vassall, A. (2015). Costs to Health Services and the Patient of Treating Tuberculosis: A Systematic Literature Review. Pharmacoeconomics, 33(9), 939-955. https://dx.doi.org/10.1007/s40273-015-0279-6
Günther, G., Lange, C., Alexandru, S., Altet, N., Avsar, K., & Bang, D. et al. (2016). Treatment Outcomes in Multidrug-Resistant Tuberculosis. New England Journal Of Medicine, 375(11), 1103-1105. https://dx.doi.org/10.1056/nejmc1603274
Thomas, B., Shanmugam, P., Malaisamy, M., Ovung, S., Suresh, C., & Subbaraman, R. et al. (2016). Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review. PLOS ONE, 11(1), e0147397. https://dx.doi.org/10.1371/journal.pone.0147397
Khanal, S., Elsey, H., King, R., Baral, S., Bhatta, B., & Newell, J. (2017). Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal. PLOS ONE, 12(1), e0167559. https://dx.doi.org/10.1371/journal.pone.0167559
van Hoorn, R., Jaramillo, E., Collins, D., Gebhard, A., & van den Hof, S. (2016). The Effects of Psycho-Emotional and Socio-Economic Support for Tuberculosis Patients on Treatment Adherence and Treatment Outcomes – A Systematic Review and Meta-Analysis. PLOS ONE, 11(4), e0154095. https://dx.doi.org/10.1371/journal.pone.0154095
Cremers, A. L., de Laat, M. M., Kapata, N., Gerrets, R., Klipstein-Grobusch, K., & Grobusch, M. P. (2015). Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia. PLoS ONE, 10(3), e0119861. https://doi.org/10.1371/journal.pone.0119861
Cremers, A. L., de Laat, M. M., Kapata, N., Gerrets, R., Klipstein-Grobusch, K., & Grobusch, M. P. (2015). Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia. PLoS ONE, 10(3), e0119861. https://doi.org/10.1371/journal.pone.0119861
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