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Doomsday postponed? Preventing and reversing epidemics of drug-resistant tuberculosis

Nature Reviews Microbiology volume 7, pages 81–87 (2009)Cite this article

Abstract

Extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis, now known to be present in 50 countries, heighten the threat posed by untreatable and fatal human tuberculosis (TB). To combat epidemics of drug-resistant TB, it is vital to understand why some resistant strains have greater reproductive fitness — a greater propensity to spread — than drug-susceptible strains. If public health malpractice has been a more important determinant of reproductive success than genetic mechanisms, then improved diagnosis and treatment could keep the frequency of resistant strains among TB cases low in any population. Recent data suggest that national TB control programmes that use existing drugs efficiently can postpone and even reverse epidemics of multidrug-resistant TB, although the effect of such programmes on XDR strains remains largely unknown.

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Figure 1: Worldwide distribution of multidrug-resistant tuberculosis (MDR TB) in 2006.
Figure 2: Estimated time trends in MDR TB and all TB cases.
Figure 3: Estimated new multidrug-resistant (MDR) cases among new TB cases in 35 countries.
Figure 4: Estimated trends in new MDR TB cases in relation to trends in all new TB cases.

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Acknowledgements

I thank A. Wright and M. Zignol for providing data from the 2008 WHO/IUATLD report on drug resistance and for helpful discussions about data interpretation. I also thank T. Cohen and M. Raviglione for reviewing drafts of the manuscript.

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  1. Christopher Dye is at the World Health Organization, Geneva 27, 1211, Switzerland

    Christopher Dye

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Dye, C. Doomsday postponed? Preventing and reversing epidemics of drug-resistant tuberculosis. Nat Rev Microbiol 7, 81–87 (2009). https://doi.org/10.1038/nrmicro2048

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