Drug-resistant tuberculosis: a worldwide epidemic poses a new challenge.
BACKGROUND
Although the incidence of tuberculosis (TB) in Germany is now declining, the world as a whole faces the threat of a catastrophe that will also affect the industrialized nations. The main reason, aside from TB/HIV co-infection, is the increase of resistant TB strains. The situation is already serious because of the spread of multidrug-resistant TB, i.e., TB that is resistant to the two most important antituberculous drugs, and is being further aggravated by resistance to second-line drugs as well.


METHODS
Selective review of the literature.


RESULTS
There are an estimated half a million cases of multidrug-resistant TB worldwide, and so-called extensively resistant TB (XDR-TB), with additional resistance to defined second-line drugs, is now prevalent in more than 45 countries. An accurate assessment of the situation is hampered by a widespread lack of laboratory capacity and/or proper surveillance. The problem is mainly due to inappropriate treatment, which may have many causes, but is theoretically avoidable. Aside from programmatic weaknesses, a lack of diagnostic and therapeutic tools causes difficulties in many countries.


CONCLUSIONS
Only rapid and internationally concerted action, combined with intensified research efforts and the support of the affected nations, will be able to prevent the development of a situation that will no longer be manageable even with 21(st)-century technology.
Loddenkemper
Robert
R
Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin. rloddenkemper@dzk-tuberkulose.de
Hauer
Barbara
B
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004359:Drug Therapy, Combination; D005858:Germany; D006801:Humans; D008826:Microbial Sensitivity Tests; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission
D000995:Antitubercular Agents