DRUG-RESISTANT TUBERCULOSIS IN THE 1990S

There has been an upsurge of tuberculosis in many parts of the world in the past decade, The high rates of drug-resistant tuberculosis currently reported in many countries are alarming, The most catastrophic phenomenon is the emergence of multidrug-resistant strains of Mycobacterium tuberculosis. These organisms have caused epidemic outbreaks in nosocomial and healthcare settings in the USA and some European countries. In addition to immigration, poverty, alcoholism and intravenous substance abuse, human immunodeficiency virus (HIV) infection has also had a significant impact on the prevalence of drug resistance, since amongst these patient groups a common factor giving rise to drug resistance is noncompliance. Rapid drug susceptibility tests are needed, and effective chemotherapy regimens with newly developed drugs in combination with traditional second-line antituberculosis agents for established multidrug-resistant tuberculosis me urgently being sought. There is also a quest for other novel modalities of therapy, Measures should be actively adopted to prevent the development of drug resistance. Well formulated short-course chemotherapy as initial treatment and ensurance of compliance are the most important components, The organization of a national tuberculosis control programme with a sound and adequately functioning infrastructure remains the most effective strategy to combat the resurgence of tuberculosis and to curtail drug resistance.