Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

• Published in: The Lancet (British edition) Vol. 375; no. 9728; pp. 1830 - 1843
• Main Authors: Gandhi, Neel R, Dr, Nunn, Paul, FRCP, Dheda, Keertan, PhD, Schaaf, H Simon, Prof, Zignol, Matteo, MD, van Soolingen, Dick, PhD, Jensen, Paul, PhD, Bayona, Jaime, MD
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 22.05.2010; Elsevier; Elsevier Limited
• Subjects: Acquired immune deficiency syndrome; AIDS; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Charitable foundations; Drug resistance; Drug Resistance, Bacterial - drug effects; Drug use; Extensively Drug-Resistant Tuberculosis - complications; Extensively Drug-Resistant Tuberculosis - diagnosis; Extensively Drug-Resistant Tuberculosis - epidemiology; Extensively Drug-Resistant Tuberculosis - prevention & control; General aspects; Health services; HIV Infections - complications; Human bacterial diseases; Humans; Incidence; Infectious diseases; Internal Medicine; Medical sciences; Miscellaneous; Mycobacterium; Pharmaceuticals; Public health. Hygiene; Public health. Hygiene-occupational medicine; Substance abuse treatment; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - complications; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - prevention & control; Tuberculosis, Pulmonary - prevention & control; Infection; Medicine; Treatment resistance; Tuberculosis; Multiple resistance; Bacteriosis; Mycobacterial infection; Sanitary surveillance
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(10)60410-2

Summary Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of the estimated 440 000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth were treated according to WHO standards. Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis. Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale.