Multidrug Resistant TB, TB Control, and Millennium Development Goals in Asia

  • Srikanth Prasad Tripathy
  • Sriram Prasad Tripathy

Tuberculosis is a major communicable disease, which has existed in the world for over two millennia. It affects people from all countries, more in some and less in others. The Asian countries have over 60% of the global TB burden. Specific treatment for tuberculosis was available only after the 1943 discovery of streptomycin. Many other anti-tuberculosis drugs have since been discovered and their efficacies established through controlled clinical trials. Table 1 presents a list of commonly used anti-tuberculosis drugs that are in use currently. Concerted efforts by researchers spread over the globe have provided us the scientific basis of treatment and management of TB patients through carefully conducted, controlled clinical trials in patients in different countries and settings. The World Health Organization was closely associated with most of those trials and has played a key role in the formulation of national tuberculosis programs in most countries adopting a uniform DOTS (Directly Observed Therapy, Short Course) strategy, which now forms the basis of TB control programs in 184 countries in the world (World Health Organization, 2007a). In the early introduction of chemotherapy, the incidence and prevalence of TB was high in many Asian countries. Mortality was high, diagnosis was delayed, and patients presented with advanced disease including some with acute fulminant tuberculosis, which often ended in death. Today, diagnosis is early, incidence and prevalence of tuberculosis have declined, most patients have access to drugs and are successfully treated, mortality has considerably reduced and very few patients present with acute fulminant TB. Currently available regimens under DOTS strategy include highly potent drugs of streptomycin (S), isoniazid (H), rifampicin (R), ethambutol (E), and pyrazinamide (Z), which form the sheet anchor of treatment programs in most countries. While the DOTS regimens have a potential of curing 100% of new cases in program conditions, a success rate of over 85% is acceptable.

The DOTS strategy includes a strong political commitment, uninterrupted supply of anti-TB drugs of assured quality and administration of the drugs under direct observation, provision of diagnostic facilities for sputum smear examination, and standardized documentation and reporting systems. Nearly all Asian countries have adopted the DOTS strategy in their National TB Control Programs and have seen some decline in the incidence of TB in their countries since the introduction of DOTS (World Health Organization 2007a).


Millennium Development Goal Drug Sensitivity Test Drug Resistance Surveillance Millennium Development Goal Target Green Light Committee 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Agarwal, S.P. (2007). Multidrug resistant tuberculosis. Ind J Tuberc, 52, 175–177Google Scholar
  2. Central TB Division. (2006). DOTS – Plus Guidelines. Central TB Division, Directorate General of Health Services, New Delhi, IndiaGoogle Scholar
  3. Central TB Division India. (2007). TB India 2007: RNTCP Status Report. Directorate General of Health Services, Ministry of Health and Family Welfare, New DelhiGoogle Scholar
  4. Crampin, A.C., Glynn, J.R., Traore, H., Yates, M.D., Mwaungulu, L., Mwenebabu, M., Chaguluka, S.D., Floyd, S., Drobniewski, F., Fine, P.E.M. (2006). Tuberculosis transmission attributable to close contacts and HIV status, Malawi. Emerg Inf Dis, 12, 729–735Google Scholar
  5. Dye, C. (2006). India’s leading role in tuberculosis epidemiology and control. Ind J Med Res, 123, 481–484Google Scholar
  6. Gandhi, N.R., Mall, A., Sturm, A.W., Pawinski, R., Govender, T., Lalloo, U., Zeller, K., Andrews, J., Friedland, G. (2006). Extensively drug resistant tuberculosis as a cause of death in patients coinfected with tuberculosis and HIV in a rural area of South Africa. Lancet, 368, 1575–1580PubMedCrossRefGoogle Scholar
  7. Frieden, T. (2002). Can tuberculosis be controlled? Int J Epidem, 31, 894–899CrossRefGoogle Scholar
  8. Joseph, P., Chandraskaran, V., Thomas, A., Gopi, P.G., Rajeswari, R., Rani, B., Subramani, R., Selvakumar, N., Santha, T. Influence of drug susceptibility on treatment outcome and susceptibility profile of failure to category II regimen. Indian J Tuberc, 53, 141–148Google Scholar
  9. Nathanson, E., Lambregts-van Weezenbeek, C., Rich, M.L., Gupta, R., Bayona, J., Blondal, K., Caminero, J.A., Cegielski, J.P., Danilovits, M., Espinol, M.A., Hollo, V., Jaramillo, E., Leimane, V., Mitnick, C.D., Mukherjee, J.S., Nunn, P., Pasechnikov, A., Tupasi, T., Wells, C., Raviglione, M.C. (2006). Multidrug-resistant tuberculosis management in resource limited settings. Emerg Inf Dis, 12, 1389–1397Google Scholar
  10. Pereira, M., Tripathy, S., Inamdar, V., Ramesh, K., Bhausar, M., Date, A., Iyyer, R., Acchammachary, A., Mehendale, S., Risbud, A. (2005). Drug resistance pattern of Mycobacterium tuberculosis in seropositive and seronegative HIV-TB patients in Pune, India. Ind J Med Res, 121, 235–239Google Scholar
  11. Raviglione, M.C., Smith, I.M. (2007). XDR tuberculosis – implications for global public health. New Engl J Med, 356, 656–659PubMedCrossRefGoogle Scholar
  12. Sam, I.C., Drobniewski, F., More, P., Kemp, M., Brown, T. (2006). Mycobacterium tuberculosis and rifampicin resistance, United Kingdom. Emerg Inf Dis, 12, 752–759Google Scholar
  13. Santha, T., Gopi, P.G., Rajeswari, R., Selvakumar, N., Subramani, R., Chandrasekaran, V., Rani, B., Thomas, A., Narayanan, P.R. (2006a). Is it worth treating Category I failure patients with Category II regimen? Indian J Tuberc, 52, 203–206Google Scholar
  14. Santha, T., Thomas, A., Chandrasekaran, V., Selvakumar, N., Gopi, P.G., Subramani, R., Rajeswari, N., Rani, B., Paramasivan, C.N., Perumal, N., Wares, F., Narayanan, P.R. (2006b). Initial susceptibility profile of M. tuberculosis among patients under TB programs in South India. Int J Tuberc Lung Dis, 10, 52–57PubMedGoogle Scholar
  15. Shah, N.S., Wright, A., Bai, G., Barrera, L., Boulahbal, F., Martin-Casabona, N., Drobniewski, F., Golpin, C., Havelkova, M., Lepe, R., Lumb, R., Metchcock, B., Portaels, F., Rodrigues, M.F., Rusch-Gerdes, S., Van Deun, A., Vincent, V., Laserson, K., Wells, C., Cegielski, J.P. (2007). Worldwide emergence of extensively drug resistant tuberculosis. Emerging Inf Dis, 13, 380–387CrossRefGoogle Scholar
  16. Swaminathan, S., Paramasivan, C., Ponnuraja, S., Iliayas, S., Rajasekaran, S., Narayanan, P.R. (2005). Antituberculosis drug resistance in patients with HIV and tuberculosis in South India. Int J Tuberc Lung Dis, 9, 896–900PubMedGoogle Scholar
  17. Tripathy, S.P., Menon, N.K., Mitchison, D.A., Narayana, A.S.L., Somasundaram, P.R., Stott, H., Velu, S. (1969). Response to treatment with isoniazid plus PAS of tuberculosis patients with primary isoniazid resistance. Tubercle Lond, 50, 257–268CrossRefGoogle Scholar
  18. Tuberculosis Research Centre. (2001). Low rate of emergence of drug resistance in sputum positive patients treated with short course chemotherapy. Int J Tuberc Lung Dis, 5, 40–45Google Scholar
  19. Tuberculosis Research Centre. (2003). Trends in initial drug resistance over three decades in a rural community in South India. Ind J Tuberc, 50, 75–86Google Scholar
  20. UNAIDS/World Health Organization. (2006). AIDS Epidemic Update: Geneva, December 2006Google Scholar
  21. World Health Organization. (2004). Anti-Tuberculosis Drug Resistance in the World: Report No. 3. Geneva, WHOGoogle Scholar
  22. World Health Organization. (2005). Health and the Millennium Development Goals. Geneva, WHOGoogle Scholar
  23. World Health Organization. (2006). Guidelines for the Management of Drug Resistant Tuberculosis. Geneva, WHOGoogle Scholar
  24. World Health Organization. (2007a). Global Tuberculosis Control, Surveillance, Planning, Financing. Geneva, World Health OrganizationGoogle Scholar
  25. World Health Organization. (2007b). Global Tuberculosis Epidemic Leveling Off. News Release WHO/8. 21 March 2007Google Scholar
  26. World Health Organization Regional Office for South East Asia. (2002). Tuberculosis Epidemiology and Control. Narain J.P., (ed). New Delhi, IndiaGoogle Scholar
  27. Zignol, M., Hosseini, M.S., Wright, A., Weezenbeek, C.L., Nunn, P., Watt, C.J., William, B.J., Dye, C. (2006). Global incidence of Multi-drug resistant tuberculosis. JID, 194, 479–485PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Srikanth Prasad Tripathy
    • 1
  • Sriram Prasad Tripathy
    • 2
  1. 1.National AIDS Research InstituteBhosariIndia
  2. 2.Indian Council of Medical ResearchIndia

Personalised recommendations