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Multidrug resistant to extensively drug resistant tuberculosis: What is next?

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Abstract

Drug resistant tuberculosis is a man made problem. While tuberculosis is hundred percent curable, multidrug resistant tuberculosis (MDR-TB) is difficult to treat. Inadequate and incomplete treatment and poor treatment adherence has led to a newer form of drug resistance known as extensively drug resistant tuberculosis (XDR-TB). XDR-TB is defined as tuberculosis caused by Mycobacterium tuberculosis strain, which is resistant to at least rifampicin and isoniazid among the first line anti tubercular drugs (MDR-TB) in addition to resistance to any fluroquinolones and at least one of three injectable second line anti tubercular drugs i.e. amikacin, kanamycin and/or capreomycin. Mismanagement of tuberculosis paves the way to drug resistant tuberculosis. Emergence of XDR-TB is reported world wide. Reported prevalence rates of XDR-TB of total MDR cases are; 6.6% overall worldwide, 6.5% in industrialized countries, 13.6% in Russia and Eastern Europe, 1.5% in Asia, 0.6% in Africa and Middle East and 15.4% in Republic of Korea. Better management and control of tuberculosis specially drug resistant TB by experienced and qualified doctors, access to standard microbiology laboratory, co-morbitidy of HIV and tuberculosis, new anti-TB drug regimens, better diagnostic tests, international standards for second line drugs (SLD)-susceptibility testing, invention of newer antitubercular molecules and vaccines and knowing the real magnitude of XDR-TB are some of the important issues to be addressed for effective prevention and management of XDR-TB.

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Abbreviations

DOTS:

direct observation therapy strategy

INH:

isonicotinic acid hydrazide

MDR-TB:

multi drug resistant tuberculosis

SLD:

second line anti tubercular drug

SRLs:

supranational reference laboratories

XDR-TB:

extremely drug resistant tuberculosis

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Correspondence to Amita Jain.

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Jain, A., Dixit, P. Multidrug resistant to extensively drug resistant tuberculosis: What is next?. J Biosci 33, 605–616 (2008). https://doi.org/10.1007/s12038-008-0078-8

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