Erasing the world's slow stain: strategies to beat multidrug-resistant tuberculosis.
Multidrug-resistant tuberculosis (MDR) is perceived as a growing hazard to human health worldwide. Judgments about the true scale of the problem, and strategies for containing it, need to come from a balanced appraisal of the epidemiological evidence. We conclude in this review that MDR is, and will probably remain, a locally severe problem; that epidemics can be prevented by fully exploiting the potential of standard short-course chemotherapy (SCC) based on cheap and safe first-line drugs; and that best-practice SCC may even reduce the incidence of MDR where it has already become endemic. On the basis of the available, imperfect data, we recommend a three-part response to the threat of MDR: widespread implementation of SCC as the cornerstone of good tuberculosis control, improved resistance testing and surveillance, and the careful introduction of second-line drugs after a sound evaluation of cost, effectiveness, and feasibility.
Dye
Christopher
C
Communicable Diseases, World Health Organization, CH-1211 Geneva 27, Switzerland. dyec@who.int
Williams
Brian G
BG
Espinal
Marcos A
MA
Raviglione
Mario C
MC
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D014943:Global Health; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000502:physiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control
D000995:Antitubercular Agents