DRUG-RESISTANT TUBERCULOSIS IN THE 1990S

There has been an upsurge of tuberculosis in many parts of the world i n the past decade, The high rates of drug-resistant tuberculosis curre ntly reported in many countries are alarming, The most catastrophic ph enomenon is the emergence of multidrug-resistant strains of Mycobacter ium tuberculosis. These organisms have caused epidemic outbreaks in no socomial and healthcare settings in the USA and some European countrie s. In addition to immigration, poverty, alcoholism and intravenous sub stance abuse, human immunodeficiency virus (HIV) infection has also ha d a significant impact on the prevalence of drug resistance, since amo ngst these patient groups a common factor giving rise to drug resistan ce is noncompliance. Rapid drug susceptibility tests are needed, and e ffective chemotherapy regimens with newly developed drugs in combinati on with traditional second-line antituberculosis agents for establishe d multidrug-resistant tuberculosis me urgently being sought. There is also a quest for other novel modalities of therapy, Measures should be actively adopted to prevent the development of drug resistance. Well formulated short-course chemotherapy as initial treatment and ensuranc e of compliance are the most important components, The organization of a national tuberculosis control programme with a sound and adequately functioning infrastructure remains the most effective strategy to com bat the resurgence of tuberculosis and to curtail drug resistance.