How to manage multidrug resistant tuberculosis?
Q: A person known to me suffered from MDR tuberculosis (all primary drugs and few secondary drugs failed). Subsequently he underwent pneumonectomy and his left lung was completely removed (2 years back). Then he was put on secondary drugs. He did not take medicines for 15 days in 7 months ago, resulting in sputum getting positive. Moreover, fistula was formed and a permanent window has been made on left side for draining out the pus. The temperature did not settle since then. Recently he developed rashes on the body due to which medicines have been stopped for about 3 weeks. The patient for the last three weeks is having very high fever. It goes upto 104.8 and normally it remains close to 101. He takes about 5 paracetamol tablets everyday. Before the development of rashes, he was taking Ofloxacin, ethionamide, pyrazinamide, and isonex. I request you to suggest next course of treatment.
A:Multidrug resistant tuberculosis is a dreaded problem, since it is very difficult to achieve a satisfactory outcome with treatment, and the organism can spread to others and cause them serious problems. The first approach is isolation, with rest and good diet. The second option is multiple antibiotic therapy, including a daily injectable agent. The third option includes old therapies such as pneumothorax or pneumoperitoneum to try and collapse the infected lung - although this may not be possible. Fourthly, a very experienced surgeon may be able to do massive surgical removal of infected tissue, but, again, this may present an impossible challenge. If the left lung was completely removed and the left thorax is now infested with very resistant bacteria, the only hope may be a very dangerous and deforming operation, i.e., thoracoplasty. Unfortunately, this sounds like an insurmountable problem for this very sick patient.