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Semin Respir Crit Care Med 2008; 29(5): 499-524
DOI: 10.1055/s-0028-1085702
© Thieme Medical Publishers

Epidemiology and Treatment of Multidrug Resistant Tuberculosis

Carole D. Mitnick1 , Sasha C. Appleton2 , Sonya S. Shin3
  • 1Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
  • 2Partners In Health, Boston, Massachusetts
  • 3Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
Further Information

Publication History

Publication Date:
22 September 2008 (online)

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ABSTRACT

Multidrug resistant tuberculosis is now thought to afflict between 1 and 2 million patients annually. Although significant regional variability in the distribution of disease has been recorded, surveillance data are limited by several factors. The true burden of disease is likely underestimated. Nevertheless, the estimated burden is substantial enough to warrant concerted action. A range of approaches is possible, but all appropriate interventions require scale-up of laboratories and early treatment with regimens containing a sufficient number of second-line drugs. Ambulatory treatment for most patients, and improved infection control, can facilitate scale-up with decreased risk of nosocomial transmission. Several obstacles have been considered to preclude worldwide scale-up of treatment, mostly attributable to inadequate human, drug, and financial resources. Further delays in scale-up, however, risk continued generation and transmission of resistant tuberculosis, as well as associated morbidity and mortality.

KEYWORDS

Tuberculosis - drug resistance - surveillance - management - epidemiology

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1 Results from the four reports of the Global Anti-Tuberculosis Drug Resistance Surveillance Project are adapted and summarized in Table [1]. For countries for which no representative survey results have been published, data from the most recent published reports of convenience samples are included.

2 Personal communication, P. Zintl, chair, drug-procurement subgroup, June 2008.

Carole D MitnickSc.D. 

Department of Global Health and Social Medicine, Harvard Medical School, 800 Boylston St.

47th Fl., Boston, MA 02199

Email: cmitnick@pih.org

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