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Epidemiology and molecular mechanisms of drug-resistant tuberculosis

Neil W Schluger, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide, and resistance to commonly used antituberculous drugs is increasing.

Drug-resistant tuberculosis was recognized shortly after the introduction of effective chemotherapy in the late 1940s. Streptomycin was the first drug to be used widely. Patients who received this drug usually had marked and rapid clinical improvement, but treatment failures were common after the first three months of therapy. Isolates of Mycobacterium tuberculosis obtained from patients with treatment failure were invariably streptomycin resistant. The rapid development of resistance to single-agent therapy led to the principle of multiagent chemotherapy of TB that remains the cornerstone of treatment.

The epidemiology and molecular basis of drug-resistant TB will be reviewed here. The diagnosis and treatment of drug-resistant strains of M. tuberculosis are discussed separately. (See "Treatment of drug-resistant pulmonary tuberculosis in adults".)


There are a series of definitions used in describing the different types of drug-resistant tuberculosis (TB):

The term "drug-resistant TB" refers to cases of TB caused by an isolate of M. tuberculosis that is resistant to one of the first-line anti-TB drugs: isoniazid, rifampin, pyrazinamide, ethambutol, or streptomycin.

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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