The American Journal of Medicine
Volume 121, Issue 10 , Pages 835-844, October 2008

Extensively Drug-resistant Tuberculosis

  • Miguel G. Madariaga, MD

      Affiliations

    • Section of Infectious Diseases, University of Nebraska Medical Center, Omaha
    • Corresponding Author InformationRequests for reprints should be addressed to Miguel G. Madariaga, MD, Section of Infectious Diseases, University of Nebraska Medical Center, 988106 Nebraska Medical Center, Omaha, NE 68198-8106
  • ,
  • Umesh G. Lalloo, MBChB, MD, FCCP

      Affiliations

    • Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
  • ,
  • Susan Swindells, MBBS

      Affiliations

    • Section of Infectious Diseases, University of Nebraska Medical Center, Omaha

Abstract 

Extensively drug-resistant tuberculosis (XDR-TB) is defined as Mycobacterium tuberculosis infection that is resistant to isoniazid, rifampin, any fluoroquinolone, and any injectable drug (amynoglicosides or polypetides). Although initially described in South Africa, it has emerged as a global threat, and cases have been reported from several countries, including the United States. XDR-TB has emerged mainly as a consequence of previous inadequate or poorly administered treatment, from failure of the public health infrastructure. As the diagnosis of this condition requires antibiotic susceptibility confirmation, a broad network of reference laboratories and the development of faster and more accurate tests for the identification of active cases of tuberculosis are urgently required. The treatment of XDR-TB is challenging and requires the use of multiple second-line drugs and, potentially, surgery. Infection control measures do not differ from those used for susceptible cases but may require more stringent application.

Keywords: Extensively drug resistant, HIV, Tuberculosis

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PII: S0002-9343(08)00434-8

doi:10.1016/j.amjmed.2008.04.015

The American Journal of Medicine
Volume 121, Issue 10 , Pages 835-844, October 2008