Drug-resistant and atypical mycobacterial disease. Bacteriology and treatment

The treatment of drug-resistant mycobacterial disease requires excellent laboratory technology combined with an effective means of monitoring patients for drug toxicity and assuring patient compliance in treatment. Most tuberculosis is readily treated with easily administered, well-tolerated antituberculous combination medications such as isoniazid-ethambutol hydrochloride or isoniazid-rifampin. Primary drug-resistant tuberculosis is prevalent in many developing countries; drug resistance in the United States is generally acquired through inadequate or irregular drug ingestion. Drug-resistant tuberculosis and many "atypical" mycobacterioses required carefully designed drug regimens based on accurate drug susceptibility studies. Occasionally, patients with certain types of infection will have isolated pulmonary involvement for which surgical extirpation is beneficial. Despite the continued decline in the incidence of tuberculosis, atypical mycobacterial disease has remained constant and may eventually become the most prevalent mycobacteriosis in the United States.