Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary

Excerpt

A large percentage of tuberculosis (TB) cases are susceptible to available effective TB antibiotics. Nonetheless, multidrug-resistant TB (MDR TB) is a major and growing global threat. An estimated 4.8 percent of all new and previously treated TB cases diagnosed worldwide in 2006—a total of 489,139 cases (95 percent confidence level, 455,093–614,215)—were MDR TB (WHO, 2008b). However, many consider this global figure to be a significant underestimate, and in many regions around the world the rates are much higher. Drug resistance is perpetuated for a number of reasons, including the failure to ensure regular treatment with high-quality existing drugs and the fact that only a few drugs to treat TB are available, and they are very old. The rifamycins, the last new treatments for TB, were developed in the 1960s. Because patients with MDR TB are resistant to treatment with first-line drugs, they must be treated with second-line drugs that are more expensive, have more side effects, often require injection, and involve longer treatment.

The goals of the workshop summarized in this report were to understand the magnitude and nature of the drug resistance problem; to assess the adequacy of the current global response; and to examine in depth three primary areas of concern—diagnosis, drug supply, and treatment delivery. The workshop brought together a wide range of experts and organizations engaged in the global effort to combat TB so they could share information, develop an understanding of the challenges, and consider opportunities and strategies for confronting the problem.