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Diagnosis and treatment of extensively drug-resistant tuberculosis

Scott K Heysell, MD, MPH
Gerald Friedland, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Multidrug-resistant tuberculosis (MDR-TB) has emerged in epidemic proportions in the wake of widespread HIV infection among the world's poorest populations, including sub-Saharan Africa. Extensively drug-resistant tuberculosis (XDR-TB) was first reported in 2006 and has now been documented on six continents [1]. These trends are critically important for global health since the mortality from drug-resistant tuberculosis (TB) is high, and second- and third-line therapeutic agents are less potent, less tolerable, less readily available, and more costly than first-line therapies.

This topic will focus specifically on the clinical manifestations, diagnosis, treatment, and prevention of XDR-TB. The epidemiology of XDR drug resistance is discussed elsewhere. (See "Epidemiology of extensively drug-resistant tuberculosis".)

Information on MDR-TB, drug-susceptible TB, and the diagnosis of drug-susceptible TB are discussed in detail elsewhere. (See "Clinical manifestations and complications of pulmonary tuberculosis" and "Epidemiology, clinical manifestations, and diagnosis of tuberculosis in HIV-infected patients" and "Treatment and prevention of drug-resistant tuberculosis".)


The clinical features of extensively drug-resistant tuberculosis (XDR-TB) are indistinguishable from those of drug-susceptible tuberculosis (TB). There are currently no symptoms, signs, exam findings, or radiographic or laboratory tests that have been validated to differentiate XDR-TB from other less-resistant types of TB. (See "Clinical manifestations and complications of pulmonary tuberculosis".)


Multidrug-resistant tuberculosis (MDR-TB) is defined as laboratory-confirmed resistance to the two most potent first-line medications, isoniazid and rifampin [2]. Extensively drug-resistant tuberculosis (XDR-TB) is defined as resistance to both isoniazid and rifampin with additional resistance to at least one fluoroquinolone and one injectable agent (amikacin, kanamycin, or capreomycin) [3,4].


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Literature review current through: May 2017. | This topic last updated: May 03, 2016.
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