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The ‘frozen state’ of drug‐resistant tuberculosis: notes from the field in Abkhazia
Author(s) -
Majumdar S.,
O'Brien D.,
Hurtado N.,
Hewison C.,
du Cros P.
Publication year - 2011
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2011.02617.x
Subject(s) - medicine , tuberculosis , drug , state (computer science) , pharmacology , pathology , algorithm , computer science
The success since 2004 in stabilising the global tuberculosis (TB) epidemic is being undermined by the emergence of drug-resistant TB (DR-TB). This form of TB is more difficult and costly to diagnose, treat and cure. In 2009, the World Health Assembly declared DR-TB a ‘global public health threat’ that threatens to undermine the sustainability of TB programmes. This global resolution aims to achieve universal access to diagnosis and treatment of DR-TB by 2015. However, only 11% of notified multi– DR-TB (MDR-TB) cases received treatment in 2009. The response to DR-TB must focus on the strengthening of national TB programmes and on the scaling up of services to diagnose patients and make treatment accessible. We need to pursue the goal of universal access to these services, coupled with the urgent development of new drugs, point of care diagnostics and tools to achieve the ultimate aim of eradication of the disease. DR-TB includes MDR-TB, defined as resistance to at least isoniazid and rifampicin – the two most efficacious drugs for treating TB – and extensively DR-TB (XDR-TB), which has additional resistance to a fluoroquinolone (levofloxacin, ofloxacin, moxifloxacin) and one or more second-line injectable antibiotics (kanamycin, amikacin or capreomycin) – the most effective of the second-line drugs. It also includes monoDR-TB or polyDR-TB – resistance to any other first-line drugs that is not MDR-TB or XDR-TB. These patterns of resistance are important to report, as the standard 6-month TB treatment regimen cannot be used if present. Often second-line drugs are required, though rarely available in most settings, resulting in treatment failure and amplification of resistance.