Current strategies in the treatment of multidrug-resistant tuberculosis

Abstract

Objective: The objective of the study was to analyze and review the current knowledge about the principles of treatment of multidrug-resistant tuberculosis (MDR-TB), World Health Organization treatment regimen to treat MDR-TB, mechanism of resistance, and risk factors for emergence of resistance, and novel antitubercular drugs (ATDs) available and control measures to improve treatment outcomes of MDR-TB. Methods: Various articles were reviewed from PubMed and other databases and were analyzed to write the review. Results: Mycobacterium is a largely curable infectious disease if proper treatment should be followed. The success of the treatment depends on the designing of proper treatment regimen and patient adherence to that medication. Conclusion: Mycobacterium tuberculosis is now the most lethal infectious pathogen. Drug resistance has become a major problem in the treatment of TB. In MDR-TB, the bacteria is resistant to at least isoniazid (INH) and rifampicin (RIF), and in extensively drug-resistant TB the bacteria is resistant to INH, RIF, any fluoroquinolone, and at least one of three injectable second-line drugs for TB such as kanamycin, capreomycin, and amikacin. More recently, a more worrying situation has emerged with the description of M. tuberculosis strains that have been found resistant to all antibiotics that were available for testing, a situation labeled as totally drug resistant-TB. Other reasons like poor planning by the authorities and the government may also result in the emergence of resistant strain. Rather than the effective chemotherapy and the moderately protective vaccine, new anti-TB agents, and novel controlled release nanoparticulate system like polymeric nanocarrier systems containing existing ATDs are urgently needed to decrease the global incidence of TB.