Multidrug-Resistant Tuberculosis

Abstract

The incidence of tuberculosis, especially multidrug-resistant tuberculosis (MDR-TB), has increased significantly in recent years. Outbreaks of MDR-TB have occurred in hospitals, homeless shelters, and correctional institutions. MDR-TB is frequently associated with human immunodeficiency virus infection and prior antituberculous therapy. To minimize emergence of resistance, a four-drug regimen for initial, empiric treatment of tuberculosis is recommended. Susceptibility testing should be performed on all isolates to guide further therapy and define local resistance patterns. Directly observed therapy administered twice or thrice weekly can be used to ensure compliance. For resistant organisms, treatment with at least two drugs to which the organism is sensitive is recommended. Cure of MDR-TB is difficult to achieve and mortality is high. Surgery may provide a useful adjunctive therapy in advanced cases. The optimal prophylactic regimen for exposure to MDR-TB and/or skin test conversion remains to be determined. Current efforts to control intra-institutional transmission of tuberculosis have focused on prompt case identification, use of disposable particulate respirator masks, and negative air flow ventilation (when available). Ultraviolet germicidal irradiation has been advocated as an effective and economical means of reducing institutional transmission.