TB Can Be Immune Disease Drugs

Multidrug Resistant Tuberculosis (MDR TB)

Multi-Drug Resistance dalam pengobatan TB menjadi masalah kesehatan masnyarakat di sejumlah negara dan merupakan hambatan terhadap program pengendalian TB secara global. Kekebalan kuman TB terhadap OAT  (obat antituberkulosis) sebenarnya telah muncul sejak lama. Kekebalan ini dimulai dari yang sederhana yaitu monoresisten, poliresisten, sampai dengan MDR dan extensive drug resistance (XDR).

WHO pada tahun 2005 melaporkan di dunia lebih dari 400.000 kasusMDR TB terjadi setiap tahunnya sebagai akibat kurang good basic handling and transmission of TB cases strains of germs that are resistant anti-TB drugs (OAT). Management of MDR TB is more difficult and requires more in treatment costs compared with non-MDR TB cases.



According to WHO, Indonesia is currently ranked number eight the number of cases of MDR TB from 27 countries. Preliminary data survey OAT first-line drug resistance were conducted in Central Java in 2006, show the number of MDR-TB in the case of MDR in new cases is 2.07%, the rate is increased in patients who have been treated previously, namely 16.3%. Some of the components that must be met in the management of MDR TB is the availability of laboratory facilities that are certified specifically for resistance test OAT, line TB drugs to two complete and well-trained human resources and adequate financial resources.

Definition
TB with multiple resistance which M. tuberculosis bacilli resistant to rifampicin and isoniazid, with or without other OAT 2,9,10,11. TB dual resistance can be either primary resistance and secondary resistance. Primary resistance is the resistance that occurs in patients who have never received previous OAT.
Primary resistance is found particularly in patients with HIV positive, while the secondary resistance is the resistance obtained during previous therapy in people who are sensitive obat1,12.

Factors Affecting OAT (Anti Tuberculosis)
Pathways involved in the development and deployment of multiple resistance TB. Basil had mutations resistant to one drug and therapy of certain OAT inadequate. Inadequate therapy can be caused by the consumption of just one drug alone (monotherapy direk) or a combination of drugs consumption but only one that is sensitive to the bacillus (indirect monotherapy). Furthermore, the secondary resistance (acquired) occurs.
The new mutation in the population growth of the bacillus causing drug resistance

that many if therapy is inadequate continues. TB patients with a secondary drug resistance can infect others in which the infected person is said to be the primary resistance. Transmission is facilitated by the presence of HIV infection, where more rapid disease progression, their infection control procedures were inadequate; and a delayed enforcement diagnostics. Drug resistance is the primary and secondary can be imported, especially from countries with a high prevalence in which a control program is inadequate. Primary drug resistance, as well as the secondary resistance, can be transmitted to other people so it can spread the disease of drug resistance in komunitas13.

There are some things causes resistance to OAT, namely:
1) The use of a single drug in the treatment of tuberculosis

2) The use of inadequate treatment regimen, the type of medicine that is lacking or in the environment there has been a high resistance to the drugs used, for example, give rifampicin and INH alone in areas with resistance to both drugs is quite high.

3) Provision of drugs irregularly, such as only eaten two or three weeks and then stopped, after two months of stops later bepindah doctor received the drug back for two or three months and then stop again, and so on.

4) The phenomenon of "addition syndrome" which is a drug added in an alloy treatment is not successful. When failure occurs because the TB bacteria are resistant to the alloy of the first, then the "surge" (addition) one drug will only add to the long list of drug-resistant only.

5) The use of the combination drug mixing is not done well, thus disturbing the bioavailability of the drug.

6) Supply of drugs that are not regular, sometimes stalled for months delivery.