Recent advances in the medical and surgical treatment of multi-drug resistant tuberculosis.
OBJECTIVE
Multi-drug resistant tuberculosis is a serious clinical problem. Extension of drug resistance to second-line anti-tuberculosis drugs in the form of the W-strain is cause for alarm. There is an urgent need for more rapid recognition of multi-drug resistant tuberculosis and newer therapeutic agents. This review summarizes the recent advances in the diagnosis and treatment of multi-drug resistant tuberculosis including surgery and new developments.


RESULTS
Multidrug resistant tuberculosis therapy is characterized by prolonged treatment, high morbidity and mortality, and high relapse rates. New diagnostic procedures that include electrophoretic and molecular hybridization techniques will allow rapid diagnosis. Several new drugs are currently in various phases of development. Moxifloxacin, a respiratory fluoroquinolone, is currently in phase III clinical development. New classes of drugs such as nitroimidazopyrans (PA-824) and diarylquinolines (R-207910) are exciting based on phase I and II data. Immunomodulation with vaccines and interferon-gamma have been unhelpful. Surgery is reserved for selected cases only. Cure rates of over 90% with reasonable morbidity and mortality has been achieved with meticulous preoperative preparation, patient selection and careful surgical technique.


CONCLUSIONS
Newer drugs and defined indications for surgery should provide improved cure rates, with reduced duration of treatment for multi-drug resistant tuberculosis.
Lalloo
Umesh G
UG
Division of Respiratory and Critical Care, Department of Medicine, Durban, South Africa. lalloo@ukzn.ac.za
Naidoo
Rishendran
R
Ambaram
Anish
A
D000995:Antitubercular Agents / Q000627:therapeutic use*; D006801:Humans; D011013:Pneumonectomy; D032581:Tuberculosis Vaccines / Q000627:therapeutic use*; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*; D014397:Tuberculosis, Pulmonary / Q000628:therapy*
D000995:Antitubercular Agents; D032581:Tuberculosis Vaccines