User:Benfromdc/sandbox

Plan: Prioritize Lead, Epi, Mechanism, XDR-TB sections, and simplifying Treatment section. Minimize primary sources, focus on useful information and relevance, reduce tangential info Resources: WHO TB data. NEJM/Lancet/JAMA review articles, CDC and WHO statements/handbooks Use of acrolinx: Will wait to see what this shows, anticipate that sentences are too long Clinical specifics: I will aim to minimize clinical info, and discuss risk factors, dx, prognosis and treatments only insofar as they differ from non-resistant TB. I'll add more links back to the main TB page. Links: link more heavily back to the TB page Jargon: focus on simplifying the sections on risk factors, treatment Images: Add a few images at the top showing the TB organism or a diagnostic modality, or a WHO-style schematic drawing

Section-by section plan: Lead: Update lead to include more general information on the burden of MDR-TB, i.e. what is the cost, the mortality and morbidity worldwide Update lead to include why resistance is a big deal—> i.e. mortailty Explicitly explain how resistance develops One paragraph about the treatment course and prognosis of MDR TB Brief line about the history of resistance. Hyperlink the first line back to the TB article

Epi: Russian prisons part seems overlong— add a section about China and India Reduce reliance on primary sources Mechanism: Link back to the TB article again for why TB is hard to kill Brief summary of the TB organism XDR-TB: Add prognosis and relevance Prevention: Much work to do here at the beginning of the article. Explain explicitly how inadequate treatment causes resistance. Explain published evidence for efficacy of DOT vs other structures Add a section about funding of TB research vs other common diseases Delete the last line (or check the source) DOTS-Plus: Add a section about the WHO programs in China which appear to be working well. Treatment: Prioritize the timeline, prognosis, and toxicities of treatment, in a section at the beginning Try to minimize the how-to aspects and simplify the list of drugs. Add some sources for all this stuff

Benfromdc (talk) 16:42, 27 November 2016 (UTC)

Multi-drug-resistant tuberculosis (MDR-TB, also known as Vank's disease) is defined as a form of TB infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB drugs,[1][2] isoniazid (INH) and rifampicin (RMP).[3]

Five percent (5%) of all TB cases across the globe in 2013 were estimated to be MDR-TB cases, including 3.5% of newly diagnosed TB cases, and 20.5% of previously treated TB cases.[2] While rates of MDR-TB infections are relatively low in North America and Western Europe, they are an increasingly serious problem worldwide, in particular in areas of the Russian Federation, the former Soviet Union and other parts of Asia.[4]

MDR-TB infection may be classified as either primary or acquired.[5] Primary MDR-TB occurs in patients who have not previously been infected with TB but who become infected with a strain that is resistant to treatment. Acquired MDR-TB occurs in patients during treatment with a drug regimen that is not effective at killing the particular strain of TB with which they have been infected. Rates of primary MDR-TB are low in North America and Western Europe: in the US in 2000, the rate of primary MDR-TB was 1% of all cases of TB nationally.[5] Most cases of acquired MDR-TB are due to inappropriate treatment with a single anti-TB drug, usually INH. This can occur due to a medical provider, such as a doctor or nurse, improperly prescribing ineffective treatment, but may also be due to the patient not taking the medication correctly, which can be due to a variety of reasons, including expense or scarcity of medicines, patient forgetfulness, or patient stopping treatment early because they feel better.[6]

Treatment of MDR-TB requires treatment with second-line drugs, usually four or more anti-TB drugs for a minimum of 6 months, and possibly extending for 18–24 months if rifampin resistance has been identified in the specific strain of TB with which the patient has been infected.[6] In general, second-line drugs are less effective, more toxic and much more expensive than first-line drugs. Under ideal program conditions, MDR-TB cure rates can approach 70%.[6]