Of Testing and Treatment: Implications of Implementing New Regimens for Multidrug-Resistant Tuberculosis

David Wesley Dowdy, Grant Theron, Jeffrey Tornheim, Robin Warren, Emily Kendall

Research output: Contribution to journalArticle

Abstract

A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.

Original languageEnglish (US)
Pages (from-to)1206-1211
Number of pages6
JournalClinical Infectious Diseases
Volume65
Issue number7
DOIs
Publication statusPublished - Oct 1 2017

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Keywords

  • drug resistance
  • microbial
  • microbial sensitivity tests
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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