Multidrug and extensively drug-resistant tuberculosis from a general practice perspective

Abstract

BM Yashodhara1, Choo Beng Huat1, Lakshmi Nagappa Naik1, Shashikiran Umakanth2, Manjunatha Hande2, Joseph M Pappachan31Department of Medicine, Melaka Manipal Medical College, Melaka, India; 2Department of Medicine, Kasturaba Medical College, Manipal; 3Department of Medicine, Kottayam Medical College, Kerala, IndiaAbstract: Despite intensive efforts to eradicate the disease, tuberculosis continues to be a major threat to Indian society, with an estimated prevalence of 3.45 million cases in 2006. Emergence of multidrug-resistant tuberculosis has complicated eradication attempts in recent years. Incomplete and/inadequate treatment are the main causes for development of drug resistance. Directly observed therapy, short-course (DOTS) is the World Health Organization (WHO) strategy for worldwide eradication of tuberculosis, and our country achieved 100% coverage for DOTS through the Revised National Tuberculosis Control Program in 2006. For patients with multidrug-resistant tuberculosis, the WHO recommends a DOTS-Plus treatment strategy. Early detection and prompt treatment of multidrug-resistant tuberculosis is crucial to avoid spread of the disease and also because of the chances of development of potentially incurable extensively drug-resistant tuberculosis in these cases. This review discusses the epidemiologic, diagnostic, and therapeutic aspects of multidrug-resistant tuberculosis, and also outlines the role of primary care doctors in the management of this dangerous disease.Keywords: multidrug-resistant, extensively drug-resistant, tuberculosis, general practice