[Multiresistant tuberculosis]

Multiresistant tuberculosis has been recognized since the advent of triple-drug therapy with isoniazid, streptomycin and PAS in the fifties, but the recently observed strains of Mycobacterium tuberculosis resistant both to isoniazid and to rifampicin, the rapid spread of the infection and the development of severe disease in HIV infected patients have raised grave problems in controlling tuberculosis in the world. The disease is difficult and expansive to treat in industrialized countries and is incurable in many developing countries. The increased prevalence of resistant strains in southeast Asia or in Subsahara Africa is a real disaster as both the incidence of tuberculosis and of HIV infection is high. It is extremely difficult or even impossible to deal with such a disaster without new antituberculosis drugs and improved means of prevention. Only a few countries have maintained surveillance of resistant strains of tuberculous bacilli and we do not have any precise and reliable image of the importance of multiresistance in the world. It is nevertheless clear that in certain major urban areas such as New York City multiresistance has increased rapidly. In order to improve on this situation, or to prevent it, it is important to recognize that resistant tuberculosis is induced by man himself directly via insufficient quality control Two types of measures are required: 1. The clinician must prescribe a therapeutic regimen including at least two, and preferably three, drugs active against the infecting strain. 2. Patient compliance to both dose and frequency is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)