[Multiple drug resistance: a threat for tuberculosis control]

Area of Science:

• Public Health
• Infectious Diseases
• Microbiology

Context:

• Drug-resistant tuberculosis (TB) has re-emerged as a significant global health threat, particularly multidrug-resistant TB (MDR-TB) in HIV-infected populations.
• Standard short-course chemotherapy (SSCC) with first-line drugs shows poor outcomes for MDR-TB patients.
• Global anti-TB drug resistance surveys highlight widespread resistance, with high prevalence in specific regions like the former Soviet Union, China, and Ecuador.

Purpose:

• To summarize the current state of drug-resistant tuberculosis (TB) and multidrug-resistant TB (MDR-TB).
• To emphasize the importance of the directly observed treatment short (DOTS) strategy in TB control and prevention of drug resistance.
• To highlight the need for expanded access to second-line drugs for MDR-TB management.

Summary:

• Drug resistance in tuberculosis (TB) has become a major concern, with multidrug-resistant TB (MDR-TB) outbreaks reported globally.
• The directly observed treatment short (DOTS) strategy is the most effective method for TB control, reducing transmission and preventing drug resistance.
• Despite progress, significant gaps remain in addressing MDR-TB, necessitating strategies like DOTS-Plus to improve access to second-line drugs.

Impact:

• Effective implementation of DOTS saves lives by decreasing TB transmission, reducing the emergence of drug resistance, and improving individual patient outcomes.
• The World Bank recognizes DOTS as a highly cost-effective intervention, recommending its integration into primary healthcare.
• The DOTS-Plus Working Group aims to enhance access to essential second-line anti-TB drugs for global TB control programs.