In-depth Investigation: Causes, Effects, and Management of MDR-TB

This essay provides a comprehensive overview of multidrug-resistant tuberculosis (MDR-TB), examining its causes, effects, and management. It delves into the microbiological adaptations, medical errors, and patient non-compliance that contribute to the development of MDR-TB. The essay explores the effects of MDR-TB, including economic, psychological, and social impacts, such as job loss, social isolation, and stigma. Furthermore, it highlights the challenges of treating MDR-TB and emphasizes the need for patient education, effective treatment strategies, and public health interventions to combat this global health problem. The document references several studies to support its claims and provide evidence-based insights into the complexities of MDR-TB.

Running head: ENGLISH FOR ACADEMIC PURPOSES 1
Causes & Effects of MDR-TB
Author Name(s)
Institution
Author Note

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Abstract
MDR-TB is the short form of Multi Drug Resistant TB. As the name suggests, MDR-TB is a
specific condition where someone becomes resistant to TB drugs. There are basically two
primary TB drugs. These are the isoniazid (INH), and the other one is rifampicin (RMP). When
someone is said to be resistant to TB drugs, it means that these two drugs can no longer alleviate
the conditions. There is always a strong assumption of drug resistance, especially where a person
had a history of treatment failures or just a halted treatment.
Keywords: Tuberculosis, Resistance, MDR-TB, Isoniazid, Rifampicin

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Causes & Effects of MDR-TB
MDR-TB is a tuberculosis resistance conditions that develop as a high-level non-
response to the two drugs, the isoniazid, and rifampicin. Currently, Tuberculosis (TB) is one of
the major infectious which is causing the global mortality. Many believe that nonadherence to
the treatment and is the main cause of MDR-TB. Despite that, there has never been a sound
reason as to why patients result to nonadherence.
Causes of MDR-TB
There are mainly three causes of MDR-TB. Some of these are the errors in the medical
field, basic microbiology, and patient non-compliance (Günther et al., 2016). Fundamental
microbiology is concerned more with microbiological adaptations. That is the evolving nature of
the living organism. Gagneux, (2012) states that bacterial pathogens evolve in the human hosts
and there is nothing that can prevent such development. However, people can correct the medical
errors and encourage patient compliance to prevented the adaptation.
In medical science, pathogens acquire drug resistance from particular genetic mutations.
This modification enables them to withstand the presence of their counterpart drugs. In social
science, the failure to prescribe correct drug regimen to the patient, or their non-compliance with
the required drug plan allows TB pathogens to acquire drug-resistant mutation (Thomas et al.,
2016). Therefore, access to accurate public health services and effective chemotherapy is one
paramount factor for the reduction of MDR-TB epidemics (Banin, Hughes & Kuipers, 2017).
Lack of awareness and proper TB treatment is a significant factor for the expansion of
MDR-TB. This claim is evident in the wrong consumption of the accessible anti-TB drugs and
DOTS (Directly Observed Treatment Short Course). The study of (Trauner, Borrell, Reither &
Gagneux, 2014) discovered that limited knowledge of TB treatment chemotherapeutic

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procedures due to improper medical training. Studies show that this could also have had a great
impact on the spread of MDR-TB because poorly trained health providers cause the wrong
prescription.
Consumers non-compliance with TB drug treatment plan is another determinant to the
expansion of MDR-TB cases. Medical noncompliance can also be blamed to patients' the lack of
awareness regarding TB disease. A study by (Desai, Jain, Solanki & Dikshit, 2014) discovered
that lack of adequate patient counseling led to the lack of the understanding of the necessity to
adhere to the medical plan. Also, another possible cause of patients’ noncompliance is the
economic factors. For instance, (Thomas et al., 2016) found that despite the free anti-TB drugs
from the government, some patients with pulmonary TB might face some financial problems
paying for supplementary examinations. They might also be unable to pay for other drugs for
dealing with severe TB drug side effects. Further, the TB-drugs regimen of the prolonged taking
of multiple drugs proves difficult for some patients to adhere.
Furthermore, there are limited practical public health standards, if any, for managing
those TB patients who have acquired the infection of MDR while still going through the regular
anti-TB treatment (Thomas et al., 2016). There is a possibility of the spread of MDR-TB strain
from the emerging MDR-TB patients. In case such a thing happens, it causes the health services
to deal with a case of new TB patients coming with MDR-TB instead of the standard TB.
Effects of MDR-TB
Managing MDR-TB is more involved than managing the regular TB. MDR-TB requires
intravenous administration which is less efficient and more toxic when compared with the
conventional TB drugs treatment. MDR-TB cases have high mortality, and treatment takes an

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extended period. As a result, patients and their families suffer loss of employment, social
isolation, long-term psychological and socioeconomic effects.
Economic Effects of Treatment
Some employers are intolerant to low performance, sick leaves, and missed work days.
As a result, they can choose to terminate the contract based on lack of substantial performance at
work which creates a huge loss of income (Wingfield et al., 2016). If not terminating the
contract, they may wait for the end of the tenure of the contract and refuse to renew it with the
patient. Also, some choose to reduce the patient’s salary. On the other hand, some patients are so
weak to continue working, or they may be unable to work due to the effects of MDR-TB drugs
(Laurence, Griffiths & Vassall, 2015). Due to lack or minimized financial income, patients result
to seeking financial support from family members or friends.
Psychological Effects
MDR-TB patients feel hopelessness and fearful. Sometimes, MDR-TB is even
unavailable, and some patients cannot afford to pay. Patients also have a fear of death or
affecting their family members with the disease (Khanal et al., 2017). Many patients also become
distressed with the new style of living. MDR-TB treatment changes someone sleeping
arrangements. Patients also eat alone, and they are not able to remain close to their friends or
relatives. These outcomes make patients feel depressive and invaluable (Khanal et al., 2017).
However, this only happens to some patients as others from understanding families do not
experience isolation. In (Laurence, Griffiths & Vassall, 2015), the study finds that the economic
effects of MDR-TB discussed above as causes of physiological effects such as stress and anxiety.

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Social Effects of Diagnosis and Treatment
Every MDR-TB suffers an impact to his or her social life from the onset of diagnosis and
in the endurance of the treatment (van Hoorn, Jaramillo, Collins, Gebhard & van den Hof, 2016).
Patients change in the way they interact with other, the way they perceive themselves and the
onset of the inability to stay contributing in usual social activities. Stigma also arises from
misunderstanding and social disapproval of the patient’s characteristics and the beliefs and
norms of the culture (Cremers et al., 2015). For instance, patients also suffer discrimination and
from family and friends who think MDR-TB is contagious even while in the open air. Even after
a determination that MDR-TB is non-infectious, family and friends still consider patients as
unsafe.
Conclusion
MDR-TB has now become a global problem. Most notable instances are resulting from
two cases. Either from the physician mistakes or lack of patient’s compliance with the
susceptible TB treatment procedures. There is a great need to educate patients on the risk of non-
compliance, and also implement effective methods of countering physician mistakes of the
wrong prescription.

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References
Gagneux, S. (2012). Host-pathogen coevolution in human tuberculosis. Philosophical
Transactions of the Royal Society B: Biological Sciences, 367(1590), 850–859.
http://doi.org/10.1098/rstb.2011.0316
Trauner, A., Borrell, S., Reither, K., & Gagneux, S. (2014). Evolution of Drug Resistance in
Tuberculosis: Recent Progress and Implications for Diagnosis and
Therapy. Drugs, 74(10), 1063–1072. http://doi.org/10.1007/s40265-014-0248-y
Jain, K., Desai, M., Solanki, R., & Dikshit, R. K. (2014). Treatment outcome of standardized
regimen in patients with multidrug resistant tuberculosis. Journal of Pharmacology &
Pharmacotherapeutics, 5(2), 145–149. http://doi.org/10.4103/0976-500X.130062
Wingfield, T., Tovar, M., Huff, D., Boccia, D., Montoya, R., & Ramos, E. et al. (2016). The
economic effects of supporting tuberculosis-affected households in Peru. European
Respiratory Journal, 48(5), 1396-1410. http://dx.doi.org/10.1183/13993003.00066-2016
Laurence, Y., Griffiths, U., & Vassall, A. (2015). Costs to Health Services and the Patient of
Treating Tuberculosis: A Systematic Literature Review. Pharmacoeconomics, 33(9), 939-
955. http://dx.doi.org/10.1007/s40273-015-0279-6
Günther, G., Lange, C., Alexandru, S., Altet, N., Avsar, K., & Bang, D. et al. (2016). Treatment
Outcomes in Multidrug-Resistant Tuberculosis. New England Journal Of Medicine,
375(11), 1103-1105. http://dx.doi.org/10.1056/nejmc1603274
Thomas, B., Shanmugam, P., Malaisamy, M., Ovung, S., Suresh, C., & Subbaraman, R. et al.
(2016). Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis
Patients: A Systematic Review. PLOS ONE, 11(1), e0147397.
http://dx.doi.org/10.1371/journal.pone.0147397

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Khanal, S., Elsey, H., King, R., Baral, S., Bhatta, B., & Newell, J. (2017). Development of a
Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant
Tuberculosis (MDR-TB) Care in Nepal. PLOS ONE, 12(1), e0167559.
http://dx.doi.org/10.1371/journal.pone.0167559
van Hoorn, R., Jaramillo, E., Collins, D., Gebhard, A., & van den Hof, S. (2016). The Effects of
Psycho-Emotional and Socio-Economic Support for Tuberculosis Patients on Treatment
Adherence and Treatment Outcomes – A Systematic Review and Meta-Analysis. PLOS
ONE, 11(4), e0154095. http://dx.doi.org/10.1371/journal.pone.0154095
Cremers, A. L., de Laat, M. M., Kapata, N., Gerrets, R., Klipstein-Grobusch, K., & Grobusch,
M. P. (2015). Assessing the Consequences of Stigma for Tuberculosis Patients in Urban
Zambia. PLoS ONE, 10(3), e0119861. http://doi.org/10.1371/journal.pone.0119861
Cremers, A. L., de Laat, M. M., Kapata, N., Gerrets, R., Klipstein-Grobusch, K., & Grobusch,
M. P. (2015). Assessing the Consequences of Stigma for Tuberculosis Patients in Urban
Zambia. PLoS ONE, 10(3), e0119861. http://doi.org/10.1371/journal.pone.0119861