Multi drug and extensively drug-resistant TB (M/XDR-TB) management: Current issues

Multi Drug and Extensive Drug Resistant Tuberculosis (M/XDR-TB) has been an area of growing concern among clinicians, epidemiologists and public health workers worldwide. Lack of controlled trials in M/XDR-TB patients retard the optimal management of such patients, and guidelines that have been developed largely on expert opinion are crowed with controversies. Lack of effective drugs, improper regimens prescribed by poorly trained doctors and unreliable Drug Susceptibility Test (DST) reports add to the magnimity of the situation. Quality-assured culture and DST are indispensable for the diagnosis of M/XDR-TB. M/XDT-TB must be managed very effectively with careful use of Second-Line Drugs (SLDs) to reduce the morbidity and mortality and transmission of M/XDR-TB. M/XDR-TB is a man made problem and its emergence can be prevented by prompt diagnosis and effective use of first-line drugs in every new patient. The Programmatic Management of Drug Resistance Tuberculosis (PMDT-TB) proposed by the WHO has highlighted the comprehensive management strategy to control MDR-TB. Laboratory services for adequate and timely diagnosis of M/XDR-TB must be strengthened and programmatic management of M.XDR-TB must be scaled up as per target set by global plan. The proper use of second-line drugs must be ensured to cure existing MDR-TB, to reduce its transmission and to prevent XDR-TB. Sound infection control measures to avoid further transmission of M/XDR-TB and research towards the development of new diagnostics, drugs and vaccines should be promoted for proper control of M/XDR-TB.