Drug-Resistant Tuberculosis

This chapter discusses the clinical perspective and focuses on the clinical and molecular epidemiology, diagnosis, and clinical management of drug-resistant tuberculosis (DR-TB). Tuberculosis (TB) is far from eradicated and remains the foremost single infectious disease killer worldwide. Molecular epidemiology has played an important role in advancing our understanding of DR-TB epidemics. The emergence and spread of DR-TB is responsible for destabilizing TB control in high-burden countries. Mutations in the mycobacterial DNA can render bacilli resistant to the action of specific anti-tuberculous drugs. Empiric multi-drug resistant tuberculosis treatment is usually initiated based on an Xpert multi-drug resistant/RIF result in many high-burden countries like South Africa. The majority of patients with multi-drug resistant tuberculosis, as already outlined, can be cured with medical treatment alone, provided that medicines are available to design a drug susceptibility testing-guided treatment regimen likely effective drugs. Management of DR-TB in the setting of HIV-coinfection is challenging and associated with high mortality.