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Semin Respir Crit Care Med 2018; 39(03): 310-324
DOI: 10.1055/s-0038-1661383
Review Article
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 Sciences and Critical Care, Department of Medicine, University of Colorado Denver, Aurora, Colorado
3   Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, Colorado
,
Jose A. Caminero
4   Servicio de Neumologia, Hospital General de Gran Canaria, Las Palmas, Canary Islands, Spain
5   International Union against Tuberculosis and Lung Disease (The Union), Paris, France
› Author Affiliations
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Publication History

Publication Date:
02 August 2018 (online)

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Abstract

Drug-resistant strains of Mycobacterium tuberculosis pose a major threat to global tuberculosis control. Despite the availability of curative antituberculosis therapy for nearly half a century, inappropriate and inadequate treatment of tuberculosis, as well as unchecked transmission of M. tuberculosis, has resulted in alarming levels of drug-resistant tuberculosis. The World Health Organization (WHO) estimates that there were 600,000 cases of multidrug-resistant tuberculosis (MDR-TB)/rifampin-resistant (RR) tuberculosis in 2016, defined as strains that are resistant to at least isoniazid and rifampicin. Globally, WHO estimates that 4.1% of new tuberculosis cases and 19% of retreatment cases have MDR-TB. By the end of 2016, 123 countries had reported at least one case of extensively drug-resistant strains, which are MDR-TB strains that have acquired additional resistance to fluoroquinolones and at least one second-line injectable. It is estimated that only 22% of all MDR-TB cases are currently receiving therapy. This article reviews the management of MDR/RR-TB and updates recommendations regarding the use of shorter course regimens and new drugs.

Keywords

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