PURPOSE OF REVIEW: This review discusses the recent evidence on epidemiology, diagnosis, and treatment of drug-resistant and multidrug-resistant (MDR) tuberculosis (TB), an area where solutions for better diagnosis and treatment continually develop. RECENT FINDINGS: The prevalence of drug resistance has been constantly rising during the recent years. It has peaked in eastern European countries such as Belarus, where a record of 35.5% MDR-TB amongst new cases have been reported from Minsk. New diagnostic tools are becoming available. Xpert MTB/RIF is by far the most promising of these new techniques. Clinical management of drug-resistant TB is still cumbersome. However, after over 40 years of neglect, new drugs are becoming readily available: delamanid, bedaquiline, and PA-824 combined into innovative regimens raise hopes for substantially higher success rates. SUMMARY: The innovative diagnostic tools recently validated are changing the traditional paradigms of TB diagnosis, for too long based on sputum smear, culture, and drug susceptibility testing. New anti-TB compounds, which can be combined with several 'old' drugs with new indications, are gradually modifying the chances of cure for MDR-TB cases. Although initial evidence appears promising, the market use of new drugs must be accompanied by a serious public health approach aimed at preventing the development of further drug resistance.
PURPOSE OF REVIEW: This review discusses the recent evidence on epidemiology, diagnosis, and treatment of drug-resistant and multidrug-resistant (MDR) tuberculosis (TB), an area where solutions for better diagnosis and treatment continually develop. RECENT FINDINGS: The prevalence of drug resistance has been constantly rising during the recent years. It has peaked in eastern European countries such as Belarus, where a record of 35.5% MDR-TB amongst new cases have been reported from Minsk. New diagnostic tools are becoming available. Xpert MTB/RIF is by far the most promising of these new techniques. Clinical management of drug-resistant TB is still cumbersome. However, after over 40 years of neglect, new drugs are becoming readily available: delamanid, bedaquiline, and PA-824 combined into innovative regimens raise hopes for substantially higher success rates. SUMMARY: The innovative diagnostic tools recently validated are changing the traditional paradigms of TB diagnosis, for too long based on sputum smear, culture, and drug susceptibility testing. New anti-TB compounds, which can be combined with several 'old' drugs with new indications, are gradually modifying the chances of cure for MDR-TB cases. Although initial evidence appears promising, the market use of new drugs must be accompanied by a serious public health approach aimed at preventing the development of further drug resistance.
Authors: Giovanni Sotgiu; Rosella Centis; Lia D'ambrosio; Giovanni Battista Migliori Journal: Cold Spring Harb Perspect Med Date: 2015-01-08 Impact factor: 6.915
Authors: Knut Lönnroth; Giovanni Battista Migliori; Ibrahim Abubakar; Lia D'Ambrosio; Gerard de Vries; Roland Diel; Paul Douglas; Dennis Falzon; Marc-Andre Gaudreau; Delia Goletti; Edilberto R González Ochoa; Philip LoBue; Alberto Matteelli; Howard Njoo; Ivan Solovic; Alistair Story; Tamara Tayeb; Marieke J van der Werf; Diana Weil; Jean-Pierre Zellweger; Mohamed Abdel Aziz; Mohamed R M Al Lawati; Stefano Aliberti; Wouter Arrazola de Oñate; Draurio Barreira; Vineet Bhatia; Francesco Blasi; Amy Bloom; Judith Bruchfeld; Francesco Castelli; Rosella Centis; Daniel Chemtob; Daniela M Cirillo; Alberto Colorado; Andrei Dadu; Ulf R Dahle; Laura De Paoli; Hannah M Dias; Raquel Duarte; Lanfranco Fattorini; Mina Gaga; Haileyesus Getahun; Philippe Glaziou; Lasha Goguadze; Mirtha Del Granado; Walter Haas; Asko Järvinen; Geun-Yong Kwon; Davide Mosca; Payam Nahid; Nobuyuki Nishikiori; Isabel Noguer; Joan O'Donnell; Analita Pace-Asciak; Maria G Pompa; Gilda G Popescu; Carlos Robalo Cordeiro; Karin Rønning; Morten Ruhwald; Jean-Paul Sculier; Aleksandar Simunović; Alison Smith-Palmer; Giovanni Sotgiu; Giorgia Sulis; Carlos A Torres-Duque; Kazunori Umeki; Mukund Uplekar; Catharina van Weezenbeek; Tuula Vasankari; Robert J Vitillo; Constantia Voniatis; Maryse Wanlin; Mario C Raviglione Journal: Eur Respir J Date: 2015-04 Impact factor: 16.671