Chapter 7 : Global Impact of Multidrug Resistance

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Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by strains of resistant to at least isoniazid and rifampin. This chapter assesses the global impact of MDR-TB from the dual perspective of high-income and resource-limited countries. It also addresses the laboratory services needed for diagnosis and management strategies and discusses the future of MDR-TB. MDR-TB has been the focus of international attention since the late 1980s and early 1990s, when several outbreaks were reported in the industrialized world. The British TB Association conducted a study in 1960 to 1961 to assess the magnitude of acquired drug resistance in 38 chest clinics. This study estimated that there were 3,500 patients in Great Britain excreting drug-resistant bacilli and at least 1,800 patients with bacilli resistant to the three standard drugs of the time. It is now clear that in high-income countries, the majority of drug resistance and MDR-TB is occurring in foreign-born individuals. The majority of studies in resource-limited countries before the 1990s were not able to shed much light on the magnitude of the problem. A study of 70 patients identified as having MDR-TB showed that after careful rereview of medical and laboratory records, pulmonary MDR-TB had been misdiagnosed in 9 (13%) of them. This study underscores the fact that susceptibility test results alone are not sufficient to dictate the initiation of treatment for drug-resistant TB, and that careful clinical correlation is necessary in making the diagnosis of MDR-TB.

Citation: Espinal M, Salfinger M. 2005. Global Impact of Multidrug Resistance, p 99-114. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch7
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Figure 1

Correlation of MDR and resistance to any drug among new TB cases. The magnitude of MDR-TB strains correlates with the magnitude of TB strains with resistance to at least one drug. The majority of countries show low prevalence of both MDR-TB and TB resistant to at least one drug, with the exception of countries in Eastern Europe and other areas ( ).

Citation: Espinal M, Salfinger M. 2005. Global Impact of Multidrug Resistance, p 99-114. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch7
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Table 1

Green Light Committee—approved projects for MDRTB management

Citation: Espinal M, Salfinger M. 2005. Global Impact of Multidrug Resistance, p 99-114. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch7

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