Treatment and implications of multidrug-resistant tuberculosis for the 21st century.
Drug-resistant tuberculosis fundamentally reflects inadequate chemotherapy. To prevent increases in the prevalence of resistance, physician education and more structured treatment programs are needed. In one recent series, 80% of patients with multidrug-resistant tuberculosis (MDR-TB) had been previously managed with clear breaches of standard practice. These errors included adding a single drug to a failing regimen, failing to identify initial or acquired resistance, using an inadequate regimen, and not recognizing (and coping with) non-adherence to therapy. Both medical and surgical management should be considered in optimizing treatment of patients with MDR-TB. Optimal treatment strategies for MDR-TB are outlined in this paper. The use of susceptibility testing is strongly advised, but in situations where such laboratory services are not available, empirical management regimens are discussed.
Iseman
M D
MD
Clinical Mycobacteriology Service, The Division of Infectious Diseases, National Jewish Medical and Research Center, Denver, CO 80206, USA.
D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004502:Education, Medical, Continuing; D005544:Forecasting; D014943:Global Health; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000473:pathology
D000995:Antitubercular Agents