Multiple-Drug-Resistant Tuberculosis

The modern era of tuberculosis recently has been characterized by a rise in the number of cases of infection with multiple-drug-resistant (MDR) Mycobacterium tuberculosis. This acquisition of resistance to various established antituberculosis drugs has compromised both treatment and control programs worldwide. The rising prevalence of MDR strains has resulted in outbreaks and individual cases that are only marginally treatable and often fatal. Many investigators have described MDR tuberculosis as an iatrogenic phenomenon that has emerged as a major infectious-disease problem throughout the United States and the world. The consideration of MDR tuberculosis and of local epidemiological circumstances by clinicians has led to major changes in recommendations for initial treatment, retreatment, control, and prevention of tuberculosis in the United States.