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Tuberculosis: difficult to treat in the case of multidrug-resistance

Tuberculosis caused by mycobacteria that are multidrug-resistant is difficult to treat. The choice of antibiotics is limited and not properly evaluated.

Tuberculosis is a contagious infectious disease which usually attacks the lungs, progressively worsening, and is sometimes fatal. It is caused by a mycobacterium. In France, nearly 5000 new cases of tuberculosis were reported in 2011, especially among men, born outside France in 54% of cases.

The initial treatment of tuberculosis is based on a combination of four antibiotics (isoniazide + rifampicine +  pyrazinamide + ethambutol) for the first two months, then 2 antibiotics (isoniazide + rifampicine) for at least four months. When the mycobacterium responds to the antibiotic used, 90 to 95% of patients show a rapid clinical improvement.

When the mycobacterium is multidrug-resistant (resistant both to isoniazide and rifampicine) a treatment lasting at least 20 months with a combination of 5 antibiotics is generally recommended. The choice of treatment is made empirically, according to the bacteriological data, often from among drugs whose efficacy is uncertain and whose adverse effects are numerous.

Mortality is higher in cases of multidrug-resistance. Only 48% of patients worldwide treated in 2010 for multidrug resistant tuberculosis were cured, and 15% of the patients died.

Mortality is almost 75% in situations of extended multidrug resistance (resistance to isoniazide, rifampicine, and to two other families of antibiotic).

Multidrug-resistant tuberculosis is on the increase in France, but its frequency is particularly high in Eastern Europe and Central Asia. The difficulties of treatment and the severity of multidrug-resistant tuberculosis require quarantine measures to protect those around contagious patients.

©Prescrire 1 October 2014

"Multidrug-resistant tuberculosis: treatment is empirical, for want of robust trials" Prescrire Int 2014; 23 (153): 245-246. (Pdf, subscribers only).
Download the full review.
Pdf, subscribers only

See also:

Bedaquiline. More data
needed on this dangerous
antitubercular drug
Prescrire Int 2014;
23 (153): 232-234.
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Post-exposure tuberculosis
in children under 5 years old
Prescrire Int 2014;
23 (145): 2.
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Tuberculosis: in case of
exposure, monitor those
who are most at risk
(November 2012)
Free