Treatment standards are changed in the early stage of MDR-TB

The KCDC, published Korean guidelines for tuberculosis 4th edition, strengthen management system

In order to combat multidrug-resistant tuberculosis (MDR-TB), health authorities have changed treatment standards so that new drugs such as Bedaquiline can be used as core drugs even in the early stages of disease.

 

This is to increase the success rate of treatment.

 

The KCDC (Director Eun-Kyeong Jung) has published Korean guidelines for tuberculosis 4th edition, which includes rapid diagnosis and use of new drugs to combat multidrug-resistant tuberculosis (MDR-TB).

 

MDR-TB refers to tuberculosis caused by Mycobacterium tuberculosis resistant to two anti-tuberculosis drugs: Isoniazid and Rifampin.

 

This TB treatment guideline is the fourth revised version since the first edition of 2011, and suggests a treatment and management method for tuberculosis that fits the reality of Korea.

 

First, in order to increase the success of treatment, this amendment changed the criteria for rapid diagnosis and use of new drugs, such as diagnosing MDR TB patients more quickly and allowing new drugs to be used in the early stages.

 

To increase the success rate of MDR-TB treatment, the KCDC classified Bedaquiline (new drug), Linezolid, and Quinolone-based drugs as core drugs to be included from the beginning of treatment for MDR-TB.

 

Another new drug, Delamanid, was classified as a core drug by the WHO, but the domestic guidelines recommend that it be classified as a selective drug (C2 group) and used as an alternative to Bedaquiline.

 

The KCDC explains that if treatment is possible with the core drugs (groups A and B), the risk of side effects is reduced and patient convenience is increased.

 

Along with this, the KCDC recommended rapid susceptibility test of Isoniazid and Rifampin for the first culture strain or antibacterial smear positive sample of all tuberculosis patients to reduce the delay in the diagnosis of MDR-TB, and also recommended the rapid susceptibility test for Quinolone-based drugs that can be additionally used when MDR-TB is confirmed.

 

Therefore, the government has established and operated a Quinolone rapid susceptibility test system so that recommendations can be applied at the medical treatment site.

 

The guidelines were revised through the Joint Committee for the Revision of Korean Guidelines for Tuberculosis, which was organized by experts from the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD).

 

Based on the recommendations of the World Health Organization (WHO) in March of last year, the KCDC contained standardized MDR-TB diagnosis and treatment methods suited to the domestic reality.

 

Meanwhile, the number of new tuberculosis patients in Korea last year was 23,821 (46.4 per 100,000 people), which has been declining for 8 consecutive years since 2011.

 

The success rate of MDR-TB treatment was 64.7% in 2017, which is still low compared to 70-80% in advanced countries, and efforts to reduce disease burden are urgent.

 

The Korean guidelines for tuberculosis 4th edition will be available on May 7th through the website (www.mois.go.kr, the KCDC, TBzero, the Integrated Control System for Diseases and Health) and printed copies will be distributed to private medical institutions and local governments by the end of this month.