Extensively drug-resistant tuberculosis (XDR-TB) is a rare type of multidrug-resistant tuberculosis (MDR-TB). This type of tuberculosis (TB) is resistant to at least four of the core anti-TB drugs, including isoniazid, rifampicin, and a fluoroquinolone, and at least one of three injectable second-line drugs (amikacin, kanamycin, or capreomycin) or Bedaquiline or Linezolid. XDR-TB is a serious public health threat because it is difficult to treat and can be deadly.
If the multidrug-resistant tuberculosis has resistance to three core anti-TB drugs, including isoniazid, rifampicin, and a fluoroquinolone or one of the three second-line injectables, it is called pre-extensively drug-resistant tuberculosis or pre-XDR-TB.
Classification
MDR TB: caused by an organism that is resistant to at least isoniazid and rifampin
Pre-XDR TB: caused by an organism that is resistant to isoniazid, rifampin, and a fluoroquinolone OR by an organism that is resistant to isoniazid, rifampin, and a second-line injectable (amikacin, capreomycin, and kanamycin)
XDR TB: caused by an organism that is resistant to isoniazid, rifampin, a fluoroquinolone, and a second-line injectable (amikacin, capreomycin, and kanamycin) OR by an organism that is resistant to isoniazid, rifampin, a fluoroquinolone, and bedaquiline or linezolid
Signs and Symptoms
- Cough
- Fever
- Night sweats
- Weight loss
- Chest pain
- Shortness of breath
Diagnosis
- Sputum culture
- Drug susceptibility testing
Nursing Interventions
General nursing interventions for XDR-TB include:
- Educating the patient and their family about XDR-TB, including the importance of taking medications as prescribed, the length of treatment, and the risk of side effects.
- Monitoring the patient for side effects of medications and other complications of XDR-TB.
- Providing emotional support to the patient and their family.
Additional nursing interventions for XDR-TB include:
- Ensuring that the patient is placed in airborne isolation precautions to prevent the spread of XDR-TB to others.
- Providing the patient with respiratory support, if needed.
- Monitoring the patient's nutritional status and providing nutritional support, if needed.
- Working with the patient's healthcare team to develop and implement a treatment plan.
Additional nursing interventions that may be used for XDR-TB patients:
- Directly observed therapy (DOT): DOT is a process in which a healthcare worker watches the patient take their medications. This helps to ensure that patients are taking their medications as prescribed, which is essential for a cure.
- Adherence counseling: Adherence counseling is a process in which a healthcare worker helps the patient to understand why it is important to take their medications as prescribed and to develop strategies for overcoming any barriers to adherence.
- Social support: Social support can be important for patients with XDR-TB, as they may experience isolation and stigma. Nurses can help patients to connect with social support resources, such as support groups and patient advocacy organizations.
Nurses can also play a role in preventing the spread of XDR-TB by educating the public about the disease and its symptoms. Nurses can also advocate for policies and programs that support the prevention and treatment of XDR-TB.
Treatment
- Oral first-line drugs: High-dose isoniazid, pyrazinamide, and ethambutol
- Fluoroquinolones: High-dose levofloxacin is the first choice
- Other drugs: Bedaquiline and linezolid are strongly recommended for longer regimens