The global situation of MDR-TB
Introduction
In 1992, the Third World Congress on Tuberculosis concluded that, in spite of its global magnitude, the problem of tuberculosis was not being adequately addressed.1 It was also suggested that there was little recent information on the global magnitude of multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin. Ten years later at the Fourth World Congress on Tuberculosis, the progress in defining the global magnitude of drug-resistant tuberculosis and, specifically, MDR-TB was reviewed in detail. This manuscript discusses the history, current magnitude, and future impact of anti-tuberculosis drug resistance, with special focus on MDR-TB.
Section snippets
Chronology of the problem
Soon after the discovery of streptomycin in 1944 by Schatz and Waksman, resistance to this drug was reported.2 The British Medical Research Council (BMRC) set the bases for today's understanding of anti-tuberculosis drug resistance.3 Among BMRC's landmark contributions were the conducting of the first controlled clinical trials of treatment regimens containing streptomycin, para-aminosalicylic acid (PAS), and isoniazid from which cases of drug resistance emerged; the development of methods for
WHO/IUATLD Global Project on Drug-Resistance Surveillance
By the early 1990s developed countries resumed surveillance of drug resistance. However, the problem remained, to a large extent, undefined in the developing world.32 In 1994, WHO and IUATLD in collaboration with several partners launched the Global Project on Drug-Resistance Surveillance (DRS) to assess the magnitude of the problem and monitor trends. Guidelines for DRS in tuberculosis were prepared by a working group of worldwide experts including epidemiologists, microbiologists,
Future impact of MDR-TB
MDR-TB is one of the most important threats to tuberculosis control. It is also a man-made problem, and most countries with high prevalence have a history of poor tuberculosis control until recently. Hence, further spread of MDR-TB will depend on the efforts these countries are willing to undertake to accelerate tuberculosis control according to recognized and tested international guidelines. Curing new tuberculosis cases, majority of which are drug susceptible, with SCC, through the
Concluding remarks
Drug-resistant tuberculosis has existed since the introduction of anti-tuberculosis chemotherapy. However, the global magnitude of drug-resistant tuberculosis has not been well studied until recently. The WHO/IUATLD Global Project has been successful in defining and understanding the magnitude and insights of MDR-TB globally. While MDR-TB appears to be limited to local epidemics, expansion/strengthening of surveillance efforts must continue in order to improve our knowledge and target proper
Acknowledgments
Thanks to Adalbert Laszlo, Rajesh Gupta, Ernesto Jaramillo, and Mario Raviglione for useful comments.
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