title: Clinical management of adults and children with multidrug-resistant and extensively drug-resistant tuberculosis.
abstract: BACKGROUND
  Globally there is a burgeoning epidemic of drug monoresistant tuberculosis (TB), multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Almost 20% of all TB strains worldwide are resistant to at least one major TB drug, including isoniazid. In several parts of the world there is an increasing incidence of MDR-TB, and alarmingly, almost a third of MDR-TB cases globally are resistant to either a fluoroquinolone or aminoglycoside. This trend cannot be ignored because drug-resistant TB is associated with greater morbidity compared to drug-susceptible TB, accounts for almost 25% of global TB mortality, is extremely costly to treat, consumes substantial portions of budgets allocated to national TB programmes in TB-endemic countries and is a major threat to healthcare workers, who are already in short supply in resource-poor settings. Even more worrying is the growing epidemic of resistance beyond XDR-TB, including resistance to newer drugs such as bedaquiline and delamanid, as well as the increasing prevalence of programmatically incurable TB in countries like South Africa, Russia, India and China. These developments threaten to reverse the gains already made against TB.
  
  
  METHODS
  Articles related to MDR-TB and XDR-TB found on PubMed in all languages up to September 2016, published reviews, and files of the authors.
  To review the clinical management of adults and children with MDR- and XDR-TB with a particular emphasis on the utility of newer and repurposed drugs such as linezolid, bedaquiline and delamanid, as well as management of MDR- and XDR-TB in special situations such as in HIV-infected persons and in children.
  
  
  CONCLUSIONS
  This review informs on the prevention, diagnosis, and clinical management of MDR-TB and XDR-TB.
authors.affiliation: Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Observatory, South Africa. Electronic address: keertan.dheda@uct.ac.za.
authors.forename: K
authors.initials: K
authors.lastname: Dheda
authors.affiliation: Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, China.
authors.forename: K C
authors.initials: KC
authors.lastname: Chang
authors.affiliation: Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France; Sorbonne Université, Université Pierre et Marie Curie-Paris 6, CR7, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Guglielmetti
authors.affiliation: Harvard Medical School, Department of Global Health, and Social Medicine, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Furin
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.affiliation: Department of Pneumology and Allergology, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chisinau, Republic of Moldova.
authors.forename: D
authors.initials: D
authors.lastname: Chesov
authors.affiliation: Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Observatory, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Esmail
authors.affiliation: Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia; German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Lange
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D014943:Global Health; D006801:Humans; D017053:Infection Control / Q000379:methods; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents
keywords: Children; Clinical management; Diagnosis; Extensively drug-resistant tuberculosis; Multidrug-resistant tuberculosis