Antibiotic resistance of mycobacterium tuberculosis; mechanisms and specific therapeutic response

Abstract

Although epidemiologic indicators of tuberculosis (TB) are rapidly improving in Romania, the disease remains a high priority of the public health. In the last years, the World Health Organization (WHO) has paid particular attention to the phenomenon of multidrug resistant tuberculosis (MDR-TB), which Romania is not exempt from. As an endemic, TB has a long history. In the evolution of this disease, the etiological treatment had a later appearance, but the drug resistance phenomenon, acting as selection pressor, was highlighted from the beginning. The advanced knowledge of the drug resistance mechanisms, early imposed the idea of drug combination. The history of the development and use of chemotherapeutic agents in the treatment of TB demonstrates the difficulty in obtaining strong resilience of the therapeutic regimens and the increased risk of unsuccessful outcomes, due to the drug resistance phenomenon. Expanding the global response to MDR-TB is relatively recent, only the last two decades, but the progress has been substantial. The latest WHO guidelines for MDR-TB therapy is a “game-changer”. This article updates the new classification of anti-TB drugs by classes, their characteristics and place in the therapeutic regimes, but also the recommendations and challenges for their application.