Although progress has been made to reduce global incidence of drug-susceptible tuberculosis,
the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis
during the past decade threatens to undermine these advances. However, countries are
responding far too slowly. Of the estimated 440,000 cases of MDR tuberculosis that
occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only
a fifth were treated according to WHO standards. Although treatment of MDR and XDR
tuberculosis is possible with currently available diagnostic techniques and drugs,
the treatment course is substantially more costly and laborious than for drug-susceptible
tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a
few countries provide examples of how existing technologies can be used to reverse
the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory
capacity, infection control, performance of tuberculosis control programmes, and treatment
regimens for both drug-susceptible and drug-resistant disease will be needed, together
with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to
prevent drug-resistant strains from becoming the dominant form of tuberculosis. New
diagnostic tests and drugs are likely to become available during the next few years
and should accelerate control of MDR and XDR tuberculosis. Equally important, especially
in the highest-burden countries of India, China, and Russia, will be a commitment
to tuberculosis control including improvements in national policies and health systems
that remove financial barriers to treatment, encourage rational drug use, and create
the infrastructure necessary to manage MDR tuberculosis on a national scale.
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