Lancet Review: Drug-Resistant Tuberculosis Management Requires Rapid Genotypic and Phenotypic DST
This Lancet review addresses the growing crisis of multidrug-resistant tuberculosis, which accounts for 4.6% of TB cases globally but exceeds 25% in some Central Asian and Eastern European countries. Treatment requires 9-24 months of novel agents (bedaquiline) and repurposed drugs (linezolid, clofazimine) guided by both genotypic and phenotypic drug susceptibility testing. Clinical trials evaluating 6-month regimens are underway, and the review underscores that rapid molecular resistance detection is essential for individualizing therapy.
The original study
Management of drug-resistant tuberculosis.
- Authors
- Lange C, Dheda K, Chesov D, Mandalakas AM, Udwadia Z, Horsburgh CR
- Journal
- Lancet (London, England)
- Type
- Journal Article, Research Support, Non-U.S. Gov't, Review
- PMID
- 31526739
Original abstract
Drug-resistant tuberculosis is a major public health concern in many countries. Over the past decade, the number of patients infected with Mycobacterium tuberculosis resistant to the most effective drugs against tuberculosis (ie, rifampicin and isoniazid), which is called multidrug-resistant tuberculosis, has continued to increase. Globally, 4·6% of patients with tuberculosis have multidrug-resistant tuberculosis, but in some areas, like Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, this proportion exceeds 25%. Treatment for patients with multidrug-resistant tuberculosis is prolonged (ie, 9-24 months) and patients with multidrug-resistant tuberculosis have less favourable outcomes than those treated for drug-susceptible tuberculosis. Individualised multidrug-resistant tuberculosis treatment with novel (eg, bedaquiline) and repurposed (eg, linezolid, clofazimine, or meropenem) drugs and guided by genotypic and phenotypic drug susceptibility testing can improve treatment outcomes. Some clinical trials are evaluating 6-month regimens to simplify management and improve outcomes of patients with multidrug-resistant tuberculosis. Here we review optimal diagnostic and treatment strategies for patients with drug-resistant tuberculosis and their contacts.