Drug Resistance in Tuberculosis

  • Neil W. SchlugerEmail author
Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC)


The development of antimicrobial-resistant tuberculosis is a classic example of monotherapy selectively enriching resistant mutants so frequently that combinations of multiple drugs are required for successful treatment. Obtaining a successful outcome generally requires many months of treatment with drugs that have adverse effects on patients. Consequently, effort has focused on finding dosing regimens that can shorten treatment time. The primary drugs for treatment are isoniazid and rifampin; resistance to both of these compounds is called multidrug-resistant tuberculosis (MDR-TB). Infections that are monoresistant to isoniazid, which is common, are treated much as fully susceptible disease using a four-drug regimen. Monoresistance to rifampin, which is uncommon, is usually treated as MDR-TB using regimens that contain second-line drugs and longer treatment times. Finding optimal treatment depends on determining the susceptibility of the infecting strain to available agents. Drug resistance has historically been detected by labor-intensive bacterial culture methods that are gradually being replaced by nucleic acid-based tests. The latter depend on knowing the molecular basis of resistance and the associated nucleotide sequences in pathogen DNA, both of which are discussed. Despite considerable knowledge of M. tuberculosis drug resistance, on a global level the prevalence of drug resistance is increasing: we are failing to control tuberculosis.


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Authors and Affiliations

  1. 1.Departments of Medicine, Epidemiology and Environmental Health SciencesColumbia University Medical CenterNew YorkUSA

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