Epidemiology and treatment of multidrug resistant tuberculosis.
Multidrug resistant tuberculosis is now thought to afflict between 1 and 2 million patients annually. Although significant regional variability in the distribution of disease has been recorded, surveillance data are limited by several factors. The true burden of disease is likely underestimated. Nevertheless, the estimated burden is substantial enough to warrant concerted action. A range of approaches is possible, but all appropriate interventions require scale-up of laboratories and early treatment with regimens containing a sufficient number of second-line drugs. Ambulatory treatment for most patients, and improved infection control, can facilitate scale-up with decreased risk of nosocomial transmission. Several obstacles have been considered to preclude worldwide scale-up of treatment, mostly attributable to inadequate human, drug, and financial resources. Further delays in scale-up, however, risk continued generation and transmission of resistant tuberculosis, as well as associated morbidity and mortality.
Mitnick
Carole D
CD
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02199, USA. cmitnick@pih.org
Appleton
Sasha C
SC
Shin
Sonya S
SS
D000553:Ambulatory Care / Q000379:methods; D000995:Antitubercular Agents / Q000494:pharmacology / Q000600:supply & distribution / Q000627:therapeutic use*; D017281:Cost of Illness; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control
D000995:Antitubercular Agents