Multiple drug resistant tuberculosis: aetiology, diagnosis and outcome

Tuberculosis is an increasing problem worldwide both in terms of disease bu rden and resistance to conventional antibiotic therapy. Studies of outbreak s involving resistant strains have highlighted the need for both improved i nfection control and the rapid provision of accurate susceptibility data. E ach patient should undergo a risk assessment for possible resistance and th ose in whom risk factors exist should be investigated by means of rapid mol ecular techniques or other phenotypic methods, so that appropriate manageme nt can be instituted with minimal delay. The ultimate outcome will vary acc ording to whether the patient is immunosuppressed, the time taken to make a diagnosis, the severity of disease as well as the degree of resistance. Th e prognosis can be improved when adequate antibiotic therapy is started as soon as resistance is suspected. Adjuncts to conventional treatment, such a s surgery and perhaps immunotherapy may be considered when response to anti microbial chemotherapy has been suboptimal.