Thursday, October 23, 2014

Treatment of MDR tuberculosis mnemonic

Hi everyone! 

This is a complicated mnemonic. Too many drugs but hopefully it will help you write a SAQ on it :)

Before I get to the mnemonic, here are some general principles. 

4 drugs to which the mycobacteria are susceptible should be used. 

6 months intensive phase is followed by a continuation phase for 18-24 months.
An injectable drug like kanamycin or streptomycin is dropped in the continuation phase.

1st group:
High-dose isoniazid, pyrazinamide, and ethambutol are thought of as an adjunct for the treatment of MDR and XDR tuberculosis.

2nd group: Fluoroquinolones, of which the first choice is high-dose levofloxacin.

3rd group are the injectable drugs:
Capreomycin, amikacin, kanamycin.
Mnemonic: CAKe

4th group:
Cycloserine, aminosalicylic acid (PAS), thioamides (Ethionamide).
Mnemonic: CAT

If susceptibility to drugs is not available:
Give KEEPQ for 6 months and then PEEQ for 18 months (Drop the injectable, remember?)
Kanamycin
Ethionamide
Ethambutol
Pyrazinamide
Quinolone

If resistant to Rifampin and Isoniazid:
Give PEQS for 6 months and then PEEQ for 18 months.
Pyrazinamide
Ethambutol
Quinolone
Streptomycin
And then replace injectable Streptomycin with Ethionamide

If resistant to all first line drugs:
Quinolone + any one from CAKe + any two from CAT

That's all! 

-IkaN

Updated on 16th February, 2015:

Mnemonic for drug resistance in MDR TB:
HeR multi drug resistance. 
Resistance to H (Isoniazid) and R (Rifampin) is defined as MDR TB. 

Mnemonic for XDR TB:
Her extra fluorescent cake. 
Resistance to H (Isoniazid), R (Rifampin), any fluoroquinolone and one of the three second line injectable drugs (Capreomycin, Amikacin & Kanamycin) is defined as XDR or extensive drug resistance. 

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