Drug-resistant tuberculosis (DR-TB) has been reported to occur in more than 100 countries worldwide, and multidrug-resistant tuberculosis (MDR-TB) in at least half that many. Appropriate treatment, however, is available in only a fraction of these settings. Political and economic changes, demographic transition, and other public health problems frequently exacerbate the severity of TB and MDR-TB outbreaks. Inadequate therapy may lead to the following problems: selection for drug-resistant mutants of M. tuberculosis in a largely susceptible population, prolonged infectiousness of patients and increased transmission of drug-resistant strains, and further resistance among patients already sick with drug-resistant TB. Additionally, international market failures can limit the ability of poor countries to purchase antituberculous drugs necessary to treat DR-TB while hindering the development of new drugs to treat TB and MDR-TB.
This paper will examine the factors converging to cause DR-TB outbreaks in several settings around the world. In Russia, for example, 10% of more than 1 million prisoners are estimated to be sick with tuberculosis. Of these patients, 25-35% are believed to be sick with MDR-TB. Peru, home to one of the best TB control programs in the developing world, will illustrate the impact on the epidemic of a history of poor treatment and continued use of standardized treatment in a community with an elevated prevalence of MDR-TB. South Africa will highlight the impact of HIV on a burgeoning MDR-TB epidemic in an environment characterized by extreme inequality and high HIV prevalence.
Learning Objectives: After this session the audience will be able to describe the factors contributing to the increased incidence of MDR-TB globally and identify several "hot spots" of disease and the characteristics that have engendered outbreaks in these settings
Keywords: Antibiotic Resistance, TB
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.