Drug-Resistant Tuberculosis

In a small percentage of cases, the initial treatment does not go as planned. The medication chosen may not work for a particular infection, or the patient's body may not absorb the medications properly. Some patients fail to take the medications as instructed. In these cases, the bacteria that cause tuberculosis may become resistant to some or all of the medications. Some people have drug-resistant TB from the start, if they were infected by someone whose disease was caused by drug-resistant bacteria. Children and people with HIV or AIDS are at higher risk of developing drug-resistant TB. While 100 years ago there were no drugs to cure TB, now for every TB drug, there is at least one strain of TB-causing bacteria resistant to it.

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Drug-resistant TB is very difficult to treat and, in some cases, cannot be cured. It generally requires more and different medications for a longer period of treatment than drug-susceptible TB. A person with drug-resistant TB should be treated in a hospital by a specialist with considerable experience in managing the disease. The medications used for drug-resistant tuberculosis include the injectable antibiotics capreomycin, kanamycin, amikacin, and viomycin. Kanamycin and amikacin have not been approved by the Food and Drug Administration for treatment of tuberculosis, but doctors may choose to use them against drug-resistant TB. These two drugs can cause hearing loss. Sometimes, surgery is needed to remove areas of destroyed lung that contain germs that are inaccessible to antibiotics.

In addition to being difficult to treat, drug-resistant TB has the potential to be a major public health problem, as first-line treatments for TB become less useful.

There are various levels of drug-resistant tuberculosis. Multidrug-resistant TB (MDR-TB) is resistant to the first-line drugs rifampin and isoniazid, and may also be resistant to some other anti-TB drugs. Extensively drug-resistant tuberculosis (XDR-TB) is a newly described category of TB that is resistant to fluoroquinolone (a strong antibiotic like Cipro) and capreomycin, kanamycin, or amikacin, drugs currently used for MDR-TB. XDR-TB is extremely difficult to treat, but it is also rare. Misusing medications increases the risk of developing MDR-TB or XDR-TB. If drugs cannot be found to treat XDR-TB, it is fatal.