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Managing drug resistant tuberculosis

15 Oct 2008

Paul Chinnock

Source: BMJ (see original article)

Citation: Grant A, Gothard P, Thwaites G (2008). Managing drug resistant tuberculosis. BMJ; 337:a1110.

BMJ Publishing Group Ltd.

Drug-resistant tuberculosis (TB) is becoming more common worldwide and is an issue discussed frequently on TropIKA.net. A comprehensive article in the BMJ’s Clinical Review series provides a timely update on the management of the condition. Sections of the article do have a UK focus but it will, nevertheless, be of interest to a wider audience.

The authors point out that is 60 years since the appearance of antibiotic resistance in Mycobacterium tuberculosis was first reported. They go on to describe recent trends, including the development of extensively drug-resistant tuberculosis (XDR-TB).

Traditional laboratory methods for detecting drug resistance are slow and not generally available outside specialist laboratories. In developed countries there is increasing use of rapid molecular methods but there is an urgent need for simple, cheap alternatives for resource limited settings, some of which are now under development.

The authors note that there is no randomised controlled trial evidence specifically relating to the treatment of drug-resistant TB. Further problems are that second-line drugs are weak and toxic, and many patients have advanced disease requiring prolonged treatment.

Prevention is a key issue; priorities include prompt detection of cases, and effective treatment of drug-sensitive and drug-resistant cases.

UK guidelines on risk factors for multidrug resistant disease are discussed in the article, as are the World Health Organization guidelines for management. Tips for non-specialists and an illustrative case history are also provided. There are links to additional resources.

Note: This article is not available with open access. To see the full article a subscription to the BMJ is therefore required. In some developing countries, readers who are based in institutions may be able to access it through the HINARI programme.

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