MDR management in Syria.ppt

MDR management in Syria Drug management aspects of MDR pilot MDR TB patients in Syria: MDR rate (RH resistance) is 4.41 % among new cases in Syria and around 25-30 MDR-TB patients are expected to develop MDR annually. ( 2003, DRS study in Syria) MDR patients notified by Governorates Treating MDR patient in Syria TB care to MDR patients use to be limited due to the shortage of the second line TB drugs, and the lack of suitable TB beds and MDR management services. Most of MDR patients used to travel outside the county to Jordan seeking care in Al Mafraq Sanatorium (Massah Al-Nur). NTP submitted a proposal to GLC for the provision of 2nd line drugs to 35 MDR cases per year for a 3 years period. GLC approved the proposal and training of trainers was conducted. NTP also started the efforts to build MDR management capacity after GLC approval The First shipment Arrived in 7-2007 Preparing of MDR Units MOH specified some rooms for treating MDR patients in the intensive phase in the public hospitals in the following governorates: Aleppo: (Not ready yet because of renovation) Hums: (ready ?) Alhassaka: (ready ?) Drug management cycle Selection Selection of drugs is done based on resistance pattern and WHO guideline. standardized regimen adopted are: 6 Kn- Lf-Cs-Et –Z/18 Lf-Cs-Et for new pat 6 Cm-PAS-Cs-Et /18 PAS-Cs-Et for old All TB drugs are included in the national essential drug list The selected drugs are: - kanamycin 1g - Ofloxacin 200 mg - Cycloserine 250 mg - Ethionamide 250 mg - PAS 4gr .sachet - capreomicine 1 g Quantification Quantities needed are identified every year according to the number of MDR patients and standardized treatment regimens. Quantities are identified at the central level which help NTP to watch rational consumption and facilitate planning. We take into consideration: The long time for procurement Safety stock Expiry date. Hand Stocks. The amounts are calculated electronically . Procurement of Second-line