REFERAT

MDR

Serlyn S. K. Taek (1308011010)

Reynaldo ()

PEMBIMBING:
dr. Nikson E. Faot, Sp.P

SMF/BAGIAN ILMU PENYAKIT DALAM

RSUD PROF DR W.Z YOHANES
FAKULTAS KEDOKTERAN
UNIVERSITAS NUSA CENDANA
KUPANG
2018
 Diagnosis
suspicious of Drug
Resistance
Low Risk
TB

• Failed treatment of Category 2

• TB treatment of category 2 patients who did not
convert after 3 months of treatment
• TB patients who have a non-standard TB Tuberculosis TB cases can also be
treatment history and use quinolones and found in new TB cases. The diagnosis
second-line injections for at least 1 month. of TB-RO is based on the sensitivity
• TB patients failed treatment category 1. test of M. Tuberculosis using standard
• TB treatment of category 1 patients who did not methods available in Indonesia,
convert after 2 months of treatment. namely the method of fast test of
• TB case patients relapse, with treatment of molecular TB and conventional
category 1 and category 2 OAT. methods. Currently the fast test
• TB patients who return after loss-to-follow-up method that can be used is the
(default treatment). molecular examination with the
• Suspected TB who has a history of close contact molecular fast Test TB (TCM) and Line
with TB-RO patients, including in this case the Probe Assay (LPA). While the
prisoners in prison / detention, densely conventional methods used are
populated like dormitories, barracks, factory Lowenstein Jensen (LJ) and MGIT.
workers.
• TB-HIV co-infected patients who are neither
bacteriologically nor clinically responsive to
OAT administration (if at initial diagnosis do not
use TCM TB).
Peraturan Menteri Kesehatan Republik Indonesia.
Penanggulangan Tuberkulosis. Jakarta; 2016. 66-78 p.
 Pedoman Nasional Pengendalian

Diagnosis of MDR TB Patients Tuberkulosis. Kementrian Kesehatan

Republik Indonesia, 2014. p. 54–8.

Patients with suspected drug-resistant TB

will collect 3 specimens of sputum

Patients with negative GeneXpert Mtb

results, investigate other possibilities

The sensitivity test does not aim to confirm the

results of the GeneXpert examination, but to
find out other TB germ resistance patterns.

If there is a difference in the results between

the GeneXpert examination and the results
of the sensitivity test, the results of the
examination with GeneXpert become the
basis of diagnosis.

* Note: For patients who are at low risk for

MDR TB (beyond the 9 suspected TB drug
resistance criteria), if the GeneXpert
examination gives the Rifampicin Resistance
result, repeat the GeneXpert 1 (one) time again
with a new, upbringing species. If there is a
difference in the results of the examination,
then the final examination results are used as
reference for further follow up.
Alur Diagnosis TB Resisten Obat
 MDR OAT alloys in Indonesia
Early preparation before starting
MDR TB treatment
OAT alloys for MDR TB
patients are standard Re-history
alloys containing Examinatio
second-line and first-line n
OATs.
Examination of
psychiatric
conditions

If the diagnosis of MDR TB has Recorded

been established, prior to starting
treatment should be preliminary House visits
preparation including conducting conducted by
several investigations. district fasyankes

Examination of
supporting
baseline
.
Examination of
supporting baseline
Renal ECG check
function Electrolyte
HIV test
serum
Photothora
Heart x
Funtion
Blood
Examination Sugar
audiometric
of Thyroid examination
stimulating
hormone
Pregnancy
test

Petunjuk Teknis Manajemen Terpadu Pengendalian Tuberkulosis Resisten Obat. Jakarta: Direktorat Jenderal Pengendalian Penyakit dan
Penyehatan Lingkungan; 2014
 Treatment of MDR TB

Type of Drug Type Type Drug

Golongan-1 First line Isoniazid (H)
Rifampisin (R)
Pirazinamid (Z)
Pirazinamid (Z)
Streptomisin (S)

Golongan-2 The second-line injectable Kanamisin (Km)

Amikasin (Am)
Kapreomisin(Cm)
Golongan-3 Golongan Florokuinolon Levofloksasin (Lfx)
Moksifloksasin(Mfx)
Ofloksasin (Ofx)
Golongan-4 Obat bakteriostatik lini kedua Etionamid (Eto)
Protionamid (Pto)
Sikloserin (Cs)
Terizidon (Trd)
Para amino salisilat (PAS)

Golongan-5 Obat yang belum terbukti efikasi-nya dan belum Clofazimin (Cfz)
direkomendasikan oleh WHO untuk pengobatan Linezolid (Lzd)
standarTB RR/TB MDR Amoksilin/ Asam Klavulanat(Amx/Clv)
Klaritromisin (Clr)
Imipenem (Ipm).
Penatalaksanaan
Prognosis
Terima Kasih