Clinical Review

Multidrug resistant tuberculosis

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h882 (Published 26 February 2015) Cite this as: BMJ 2015;350:h882
  1. James Millard, clinical lecturer in global health1,
  2. Cesar Ugarte-Gil, epidemiologist2,
  3. David A J Moore, professor of infectious diseases & tropical medicine3
  1. 1Brighton and Sussex Medical School, Brighton, UK
  2. 2Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
  3. 3TB Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. Correspondence to: D A J Moore David.moore{at}lshtm.ac.uk

The bottom line

  • Multidrug resistant tuberculosis refers to tuberculosis with resistance to at least rifampicin and isoniazid

  • Multidrug resistant tuberculosis is increasingly common; however, there is a large shortfall between the estimated total number of cases and the numbers diagnosed and treated

  • Diagnosis is hampered by lack of access to quality assured diagnostics, although newer, rapid molecular and phenotypic methods may go some way to improving this situation

  • Compared with drug susceptible tuberculosis, treatment for multidrug resistant tuberculosis requires the use of drug regimens that are prolonged (18-24 months), less efficacious, and noticeably more toxic; new drugs and regimens are becoming available for the first time in decades and ongoing trials should define how best they should be used

  • Worldwide, treatment success is only around 50%; however, several settings, including some low income countries, have proved that higher success rates are achievable

Tuberculosis remains a major cause of morbidity and mortality globally, with an estimated nine million people developing the disease and 1.5 million deaths in 2013; equating to 4100 deaths a day.1 Nevertheless, considerable gains have been made in international tuberculosis control; incidence rates are decreasing (albeit slowly) and mortality has been reduced by 45% worldwide. The advent of multidrug resistant tuberculosis threatens this progress. In this review we detail the challenges faced globally in the diagnosis, treatment, and control of multidrug resistant tuberculosis and why this matters to high and low burden multidrug resistant tuberculosis settings alike.

Sources and selection criteria

We searched Medline, Embase, and Scielo with the terms “MDR TB”, “Tuberculosis, Multidrug-Resistant”. We also reviewed the World Health Organization Global Tuberculosis Report 2014 and other national tuberculosis programme reports. We included data from systematic reviews/meta-analyses, randomised controlled trials, and good quality observational studies focused on multidrug resistant tuberculosis.

What is multidrug resistant tuberculosis?

Rifampicin and isoniazid form the backbone of conventional first line treatment for tuberculosis. Multidrug …

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