MULTIPLE DRUG–RESISTANT TUBERCULOSIS

The global tuberculosis epidemic will result in an estimated 90 million new cases and 30 million deaths during the current decade. 44 Programmatic control of this devastating epidemic and clinical management of individual cases has been complicated in recent years by the widespread emergence of drug-resistant Mycobacterium tuberculosis. Rates of infection caused by multidrug-resistant (MDR) organisms, defined as resistance to at least isoniazid and rifampin, have reached critical levels in many areas of the United States and the world. 5,14 These cases of multidrug-resistant tuberculosis are associated with significantly higher rates of morbidity and mortality, and successful treatment typically necessitates prolonged courses of chemotherapy, measures to ensure patient adherence, and considerations of resectional surgery. 23 Programmatic resources to address this emerging public health problem are frequently inadequate in the areas most profoundly affected by the epidemic.