Treatment and implications of multidrug-resistant tuberculosis for the 21st century.

Drug-resistant tuberculosis fundamentally reflects inadequate chemotherapy. To prevent increases in the prevalence of resistance, physician education and more structured treatment programs are needed. In one recent series, 80% of patients with multidrug-resistant tuberculosis (MDR-TB) had been previously managed with clear breaches of standard practice. These errors included adding a single drug to a failing regimen, failing to identify initial or acquired resistance, using an inadequate regimen, and not recognizing (and coping with) non-adherence to therapy. Both medical and surgical management should be considered in optimizing treatment of patients with MDR-TB. Optimal treatment strategies for MDR-TB are outlined in this paper. The use of susceptibility testing is strongly advised, but in situations where such laboratory services are not available, empirical management regimens are discussed.