Elsevier

Tuberculosis

Volume 83, Issues 1–3, February 2003, Pages 44-51
Tuberculosis

The global situation of MDR-TB

https://doi.org/10.1016/S1472-9792(02)00058-6Get rights and content

Abstract

Drug-resistant tuberculosis has been reported since the early days of the introduction of chemotherapy. However, most of the evidence was limited to developed countries. In 1992, the Third World Congress on Tuberculosis concluded 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. Through the WHO/IUATLD Global Project on Drug-Resistance Surveillance launched in 1994, a large number of reliable and accurate data have allowed us to understand the magnitude of the problem of MDR-TB. The data available suggest that globally MDR-TB is not a problem (median = 1% in 64 countries/geographical sites surveyed) of the same magnitude as that of drug-susceptible tuberculosis. However, MDR-TB is at critical levels in specific regions of the world. Hot spots for MDR-TB include Estonia, Latvia, the Oblasts of Ivanovo and Tomsk in Russia, and the provinces of Henan and Zhejiang Provinces in China. Trends confirm that MDR-TB is limited to local epidemics but the evidence is not yet irrefutable, as many countries have only provided short-term data. Two-thirds of the world's countries and, more importantly, half of the 22 tuberculosis high-burden countries, have not yet provided data. Mathematical modelling suggests that 3.2% (or 273,000) of the world's estimated new tuberculosis cases (95% confidence intervals: 185,000 and 414,000) were MDR-TB in 2000. Adoption of DOTS to prevent the generation of resistant strains and careful introduction of second-line drugs to treat patients with MDR are the top priorities for proper control/containment 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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