MDR - TB Current Status.

ABSTRACT

Drug resistant tuberculosis has been reported since the early days of the introduction of chemotherapy, but recently multi-drug resistant tuberculosis (MDR-TB) has been an area of growing concern and is posing a threat to control of tuberculosis. A review of 63 surveys conducted between 1985 and 1994 suggested that primary and acquired MDR-TB was between 0-10.8% and 0-48% respectively. However, the qualities of these studies were variable due to the lack of proper representativeness and size of population sampled, as well as lack of standardized laboratory methods in some of them. In 1994, WHO-IUATLD carried out a surveillance which concluded that the problem is global; the median prevalence of primary and acquired multi drug resistance was 1.4% (0-14.4%) and 13% (0-54.4%) respectively. A second WHO-IUATLD global project on drug surveillance carried out in 1996-1999 in 58 countries, found that the median prevalence of primary and acquired multi-drug resistance was 1% (0-14%) and 9% (0 - 48%) respectively. Current estimates report, the prevalence of primary and acquired multidrug resistance in India as 3.4% and 25% respectively.. It must be emphasized that optimal treatment of MDR-TB alone will not curb the epidemic. Efforts must be focused on the effective use of first line drugs in every new patient so as to prevent the ultimate emergence of multidrug resistance. The use of reserve drugs to cure multi-drug resistant tuberculosis and to reduce further transmission should be considered, but only as part of well structured programmes of tuberculosis control.