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Semin Respir Crit Care Med 2013; 34(01): 044-059
DOI: 10.1055/s-0032-1333546
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Multidrug Resistant Tuberculosis

Charles L. Daley
1   Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado
2   Division of Pulmonary and Critical Care Medicine, University of Colorado Denver, Aurora, Colorado
3   Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado
,
Jose A. Caminero
4   Servicio de Neumologia, Hospital General de Gran Canaria, Las Palmas, Canary Islands, Spain
5   MDR-TB Unit, International Union against Tuberculosis and Lung Disease (The Union), Paris, France
› Author Affiliations
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Publication History

Publication Date:
04 March 2013 (online)

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Abstract

Drug-resistant strains of Mycobacterium tuberculosis have emerged as a major threat to global tuberculosis control. Despite the availability of curative antituberculosis therapy for nearly half a century, inappropriate and inadequate treatment has allowed M. tuberculosis to acquire resistance to our most important antituberculosis drugs. The epidemic of drug-resistant tuberculosis has spread quickly in some areas due to the convergence of resistant strains of M. tuberculosis in high-risk patients (e.g., those with human immunodeficiency virus/acquired immunodeficiency syndrome) and high-risk environments (e.g., hospitals and prisons). The World Health Organization (WHO) estimates that there were 650,000 cases of multidrug resistant tuberculosis (MDR-TB) in 2010, defined as strains that are resistant to at least isoniazid (INH) and rifampicin (RIF). Globally, WHO estimates that 3.7% of new tuberculosis cases and 20% of re-treatment cases have MDR-TB. By the end of 2012, 84 countries had reported at least one case of extensively drug resistant strains (XDR-TB), which are MDR-TB strains that have acquired additional resistance to fluoroquinolones and at least one second-line injectable. Recently, cases of “totally drug resistant” tuberculosis have been reported. It is estimated that only 10% of all MDR-TB cases are currently receiving therapy and only 2% are receiving quality-assured drugs. This article reviews the management of MDR and XDR-TB and highlights the updated 2011 WHO guidelines on the programmatic management of drug-resistant tuberculosis.

Keywords

tuberculosis - drug resistant - MDR-TB - XDR-TB - management