Tuberculosis Course for

English-speaking students

2.5. THE IDENTIFICATION OF МВТ DRUG

RESISTANCE
2.5. THE IDENTIFICATION OF
МВТ DRUG RESISTANCE
Mycobacterium strains are considered
to be sensitive to a given drug when the
drug administered in the critical drug
concentration (criteria of resistance)
shows a bactericidal or bacteriostatic
action.
 МВТ DRUG RESISTANCE
• Tolerance (resistance) is defined as the
decrease in sensibility to the degree/extent that
the given mycobacterium strains is capable of
multiplying under the action of a drug having a
critical or much higher concentration.
 Characteristics of drug resistant
tuberculosis

• Acquired (secondary) • Primary resistance

resistance — it is in the occurs when a person
case of such types of infected by МВТ already
tuberculosis when the resistant to one or more
strain of tubercle bacilli types of anti-tuberculosis
change from a drugs.
susceptible into resistant
phenotype during or after
a course of
chemotherapy
 Characteristics of drug resistant
tuberculosis
• Combined resistance. The World Health Organization
sums up primary and acquired resistance to determine
the spread of a resistant strain.
• Monoresistance — МВТ strains that resistant to only
one of the five first-line anti-tuberculosis drugs:
rifampicin, isoniazid, ethambutol, pyrazi-namide,
streptomycin.
• Multidrug resistance (MDR) — МВТ strains that
resistant to both isoniazid and rifampicin simultaneously.
• Polyresistance (combined) resistance — МВТ strains
resistant to two or more antituberculosis drugs without
resistance to isoniazid and rifampicin.
 Characteristics of drug resistant
tuberculosis
• MDR (Multi-Drug Resistant) bacilli and
MDR tuberculosis is the most severe form
of bacterial resistance today. MDR
tuberculosis raises a serious concern for
tuberculosis control in many countries.
 Criteria for drug resistance

• The level of given strain resistance is expressed

by the maximal concentration of a preparation
(microgram quantity in 1 ml of media), at which
the duplication of the MTB (according to number
of colony formation on dense media) can still be
observed.
• The critical concentration established for
different anti-tuberculosis drugs. The critical
concentration is of clinical importance, as it
indicates the concentration of drug in which МВТ
duplication would be sensitive.
 Lowenstein-Jensen inspissated
egg media
• Method of absolute concentrations in
Lowenstein-Jensen inspissated egg
media is widely used to determine МВТ
drug resistance.
 Drug susceptibility test on
Mycobacterium tuberculosis bacteria
These thin agar culture
plates reveal the results
of a drug susceptibility
test on Mycobacterium
tuberculosis bacteria.
The agar medium is
imbibed with various drugs
to determine to which
medications the bacteria
are susceptible.
It is apparent that each had
a different effect on the
organism’s survival.