Multidrug Resistance and Extensively Drug-Resistant Tuberculosis: Diagnosis and Management Protocols

Since the inception of the first antituberculous chemotherapeutic agent, drug resistance has been one of the most challenging problems facing the global fight to control tuberculosis. Drug resistance to antituberculous chemotherapy is a spectrum which includes mono-drug resistance (e.g. rifampicin resistance), multidrug resistance (MDR), extensively drug resistant (XDR), and finally total drug resistance (TDR). Clinical suspicion of drug resistance is a crucial step in managing tuberculosis patients. Nevertheless, the diagnosis of MDR/XDR is purely a microbiological diagnosis, based on bacteriological and molecular testing. Surveillance programs for drug resistance among tuberculosis patients, the development of advanced diagnostic tools, and the subsequent formulation of management algorithms have rendered detection and cure of such a formidable challenge a possibility.