Prevention of the emergence and spread of any type of drug-resistant tuberculosis (TB) is being addressed as part of the DOH’s overall strategy to improve TB prevention and control through ‘Stopping Tuberculosis in England: An Action plan from the Chief Medical Officer’ (published in October 2004). As well as improvements to public health surveillance systems, this critically requires fast and comprehensive detection of cases, rapid identification of drug resistance if it exists and good clinical management including measures to ensure treatment is both appropriate and completed by the patient. Patients with drug-resistant strains of TB are treated by appropriate multiple drug therapy for a minimum of six months which also helps public health control by breaking the cycle of TB transmission from infectious patients.
The National Institute for Health and Clinical Excellence (NICE) clinical guideline on the treatment and diagnosis of TB published in March 2006 includes specific guidance on treatment and rapid contact tracing of people in contact with any type of drug resistant TB. The Department’s TB toolkit (published in June 2007) aims to help commissioners and TB service providers implement the action plan in line with the NICE guideline.
NICE recommends that if a risk assessment suggests a patient has multi-drug resistant (MDR) TB, rapid diagnostic tests should be conducted for rifampicin resistance. The Health Protection Agency (HPA) reference laboratory service identifies TB cultures from national health service patients in England and determines if they are drug resistant. The selection of appropriate second line drugs for the clinical treatment of MDR TB and extensively drug resistant (XDR) TB is determined by the HPA National Mycobacterium Reference Unit (MRU), which has recently developed newer and faster methods for drug susceptibility testing. The HPA MRU also carries out DNA fingerprinting on drug resistant TB strains in England to help determine patterns of transmission and is working with the World Health Organization on the surveillance of XDR TB.