MDR-/XDR-TB management: what it was, current standards and what is ahead

Abstract

Despite killing nearly 2 million people every year, TB is arguably the most neglected disease in terms of the funding and research it receives. In many ways, multidrug-resistant TB is a result of this disregard. In high-burden countries, not many improvements have been implemented in the diagnosis and treatment tools of TB since the 1960s. Following this period, fluoroquinolones, developed for other infections, are the only highly active new drugs against TB. Multidrug- and extensively drug-resistant TB is booming worldwide as a result of insufficient control measures. Furthermore, the prevalence of this disease is substantially facilitated by the HIV epidemic. After a deadly and well-reported extensively drug-resistant TB outbreak occurred in HIV-infected patients in South Africa, the threat of an untreatable TB epidemic is receiving increased attention internationally. Nevertheless, drug-resistant management has lacked research and funding over several decades and we are now faced with many controversial issues and little research-based evidence. There are no clinical trials comparing different treatments, and current management is based on personal experiences and agreement between experts. The major challenge for the next few years is to improve the evidence base in order to develop more rational recommendations that adequately address the current problem and avoid making a bad situation worse.

Extensively Drug-Resistant Tuberculosis: A Review Article

“…In a retrospective study in Iran, successful outcome was observed in 81.2% of MDR-TB patients in comparison with 41.6% of XDR-TB patients (21). These findings indicate that patients with XDR TB have higher probability of treatment failure and mortality (22,23).…”

The changing landscape in drug resistant-tuberculosis: an analysis of recent advances

“…We were asked for a five-year review and after decades of immobility, we were very modest with our expectations. We even mentioned: 'It is unlikely that significant changes in the TB landscape will be witnessed in the next 5 years' [5]. We certainly acknowledge our misperceptions as more changes have occurred in last 5 years than in the preceding 40 ones.…”

“…In developing countries, however, the story was completely different; large numbers of DR-TB patients, limited availability of second-line drugs, and physicians were without experience on their use and toxicities [5].…”

“…In early 2009, we wrote a review about the origins of the current DR-TB epidemic and an update on the fundamentals and quality standards for DR-TB management [5]. Almost seven years has passed, but the validity of most of that text still remains in force.…”

Multi-drug resistant tuberculosis and HIV-infection

“…Фактически имеются признаки развития эпидемиологического процесса, характе ризующиеся увеличенным риском вспышки в облас тях с высоким распространением ВИЧ инфекции вследствие высокой распространенности туберкуле за с МЛУ МБТ, однако пока данных о результатах лечения среди ВИЧ инфицированных пациентов с ШЛУ туберкулезом недостаточно. Доступные ис точники сообщают о чрезвычайно высоком уровне смертности и очень коротком времени выживания таких больных [17,18].…”