The high success rate of shortened Tuberculosis (TB) treatments has been achieved by the association of bactericidal and sterilizing drugs. The main drugs are Rifampicin and Isoniazide. When Rifampicin cannot be used by resistance, the treatment is prolonged and success in healing is significantly reduced. Resistance to Rifampicin is often accompanied by resistance to Isoniazide (Multidrug resistance or MDR). WHO reports that only 44% of estimated TB cases with resistance to Rifampicin were diagnosed in 2019 (465,000 cases projected) and only 38% of estimated cases were treated, with a large proportion of cases remaining undiagnosed and untreated. In Chile, monitoring of susceptibility to first-line drugs is conducted in strains of Mycobacterium tuberculosis by molecular biology since 2014, observing a progressive increase in cases with Rifampicin resistance from 1% for that year (23 cases) to 2.2% in 2019 (65 cases). Most cases of resistance to Rifampicin correspond to cases of initial resistance. In cases with resistance to Rifampicin we carry out susceptibility study to second-line drugs in a national reference laboratory. MDR-TB therapy has low efficacy, with frequent abandonments for its long therapy time and toxicity. New non-injectable treatments and use of Clofazimine, Fluorquinolones, Linezolid and Bedaquiline are achieving a better cure rate. Recently, Chile's TB Control Program has this most effective and shorter-lasting oral therapy with these drugs.
Clinical and programatic management of multidrug resistant tuberculosisThis publication summarizes part of the information provided during a training in multidrug resistant tuberculosis (MDR-TB) for clinical specialists in all health services of Chile with the collaboration of Dr. Jose Antonio Caminero Luna and the Chilean Program of Control and Eradication of Tuberculosis (PROCET). Emphasis was placed on early, sensitive and specific diagnostic methods of resistance to drugs based on molecular biology, showing some diagnostic algorithms feasible to implement in our country. Some proposals were made for changes in the treatment of tuberculosis with resistance to drugs, especially MDR-TB, with more effective therapeutic regimens recommended by the World Health Organization (WHO).
Video observed treatment, an attractive option for the administration of tuberculosis therapy VOT (Video Observed Treatment) is a video certificated self-administration of therapy and could be complementary to DOT (Directly Observed Treatment) for the administration of ambulatory tuberculosis treatment at Primary Health Centers. Reviewed international experience and evidence indicates that VOT improves treatment adherence, empowers patients, reduces health system costs and saves patient´s transfer time to Therapy Centers. Given the high penetration of smartphones with videocall software in the Chilean population, the pre-requisites are provided to consider a VOT pilot research in Chile.
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