Chapter 17 : Extensively Drug-Resistant Tuberculosis

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It has been many years since a single agent was recommended for treatment of active tuberculosis (TB). Despite this, there is strong evidence that multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are present in all regions of the world, and there is also evidence that the incidence of drug-resistant forms of TB is increasing. Results of the survey of antituberculosis drug resistance in the world discussed in detail were published in a landmark article in the and in a longer, more-detailed monograph issued directly by the World Health Organization (WHO). The survey reported that MDR-TB cases were found in all regions of the globe and in many regions at levels far higher than had been expected. The major problem in diagnosis of XDR-TB is the lack of culture facilities for sputum in much of the world, particularly in high-burden countries. Treatment of MDR-TB and XDR-TB is largely empirical, as no controlled clinical trials of treatment regimens have been conducted. Fueled by the human immunodeficiency virus (HIV) epidemic, MDR-TB and XDR-TB have the potential to spread rapidly and cause a great deal of morbidity and mortality. Aggressive drug therapy, sometimes combined with surgery, can achieve good outcomes in a majority of cases, but these approaches are available mostly in resource-rich nations, with limited availability in countries where the disease is most common.

Citation: Schluger N. 2008. Extensively Drug-Resistant Tuberculosis, p 337-353. In Scheld W, Hammer S, Hughes J (ed), Emerging Infections 8. ASM Press, Washington, DC. doi: 10.1128/9781555815592.ch17

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