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Student Editorials

Drug resistant tuberculosis

BMJ 2008; 336 doi: https://doi.org/10.1136/sbmj.0804138 (Published 01 April 2008) Cite this as: BMJ 2008;336:0804138
  1. Matthew Anthony Kirkman, fourth year medical student1,
  2. Fu-Meng Khaw, honorary clinical senior lecturer in public health and consultant in health protection2
  1. 1Newcastle University
  2. 2Newcastle University and Health Protection Agency, London

A third of the world's population is infected with tuberculosis, and drug resistant strains demand new approaches, say Matthew Kirkman and Fu-Meng Khaw

A Cambodian nurse speaks to tuberculosis patients at a hospital in Kampong Speu province

Tuberculosis has been a scourge of humanity from at least the time of the ancient Egyptians. The agent of human tuberculosis, Mycobacterium tuberculosis, was identified 125 years ago. BCG vaccination became available more than 85 years ago, and tuberculosis antibiotics were introduced more than half a century ago. Many doctors believed that these measures would eradicate the disease, but for multiple reasons cases have risen globally since the 1980s (box 1). The World Health Organization declared tuberculosis a global emergency in 1993.1

Box 1: Reasons for the global rise in tuberculosis

  • HIV epidemic leading to tuberculosis in people co-infected with M tuberculosis

  • Emergence of drug resistant strains

  • Non-compliance with antituberculous treatment

  • Immigration from countries with high incidence of tuberculosis

  • Increasing inner city deprivation

  • Lack of awareness among communities and professionals leading to delayed diagnosis and poor control

  • Ageing population resulting in reactivation of the disease in people exposed when younger

  • Inadequate resources for a disease that many people consider yesterday's problem

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One third of the world's population is infected with tuberculosis. In most people it remains dormant and asymptomatic. However, about 10% develop active disease after a variable period,2 typically after immunosuppression. Untreated active tuberculosis may kill, with potential for transmission to other people. The emergence of multiple and, more recently, extensively drug resistant strains (MDR and XDR tuberculosis, box 2) has raised concerns, especially because XDR tuberculosis is almost …

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