Drug-resistant tuberculosis in 2017: At a crossroads
Lancet Respir Med
Authors:Dowdy DW, Theron G, Tornheim JA, Kendall EA
In this issue of The Lancet Respiratory Medicine, Dheda and colleagues present one of the most comprehensive pictures to date of the global epidemic of drug-resistant tuberculosis (DR TB).1 This comes at a time of increasing awareness of antimicrobial resistance as a global threat2 – and TB has had a 50-year head start in developing resistance to current first-line therapy. In reading about such phenomena as compensatory mutations, increasing prevalence of incurable TB, and widespread transmission of DR TB, it is easy to become disheartened. If – as suggested in modeling studies3 and recently demonstrated in KwaZulu-Natal, South Africa4 – the majority of new multidrug-resistant (MDR) and extensively drug-resistant TB cases now reflect transmission in communities rather than acquisition during treatment – is there any hope for preventing the eventual replacement of all TB by drug-resistant strains?