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Neil W. Schluger, MD

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Tuberculosis remains one of the leading causes of morbidity and mortality throughout the world. Its management has become more complex because of increased resistance to commonly used antituberculosis drugs.

This article will review the diagnosis and therapy of patients infected with drug-resistant strains of M.tuberculosis. Treatment of drug-resistant tuberculosis can be difficult, and may necessitate the use of second line drugs or resectional surgery. Therefore, management of patients with resistant disease should only be undertaken by, or in very close consultation with, experts in this area. Good patient outcomes depend upon a rapid and accurate diagnosis, and the institution, administration, and monitoring of proper therapy1.

Definitions – There are a series of definitions used in describing the different types of drug-resistant tuberculosis: 

  • The term “drug-resistant tuberculosis” refers to cases of tuberculosis caused by an isolate of Mycobacterium tuberculosis which is resistant to one of the first-line antituberculosis drugs: isoniazid, rifampin, pyrazinamide, ethambutol, or streptomycin.
  • Multidrug-resistant tuberculosis (MDR-TB) is caused by an isolate of M. tuberculosis which is resistant to two or more of the first-line chemotherapeutic agents, usually isoniazid and rifampin.
  • Primary drug-resistance is said to occur in a patient who has never received antituberculosis therapy.
  • Secondary resistance refers to the development of resistance during or following chemotherapy, for what had previously been drug-susceptible tuberculosis.

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