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| J Korean Med Assoc > Volume 49(9); 2006 > Article |
Abstract
Multidrug-resistant tuberculosis (MDR-TB), resistant to at least both isoniazid and rifampicin, poses a serious threat to global health because it requires treatment for a long duration and frequent hospitalization, and results in a considerable number of mortalities. According to a report from the World Health Organization in 2000, 3.2% of all new TB cases are MDR. In South Korea, multidrug-resistance was observed in 13% of re-treatment cases. The treatment of MDR-TB is difficult, since second-line drugs must be used, which are not as potent or as well tolerated as in the first-line drugs. Early publications on the treatment response of MDR-TB reported a considerable rate of mortality, as high as 37%. The use of 4 or 5 drugs including injectable drugs and fluoroquinolones is the fundamental of the medical treatment of MDR-TB. For patients with MDR-TB refractory to medical treatment, surgical resection could be tried. However, the candidate for the surgical resection should be selected cautiously. To overcome the low success rate of treatment among MDR-TB patients, well-designed clinical trials including newer drugs or regimens should be performed. MDR-TB has been a serious challenge to human health, especially in South Korea. To reduce the individual or social burden from MDR-TB, a commitment of government as well as clinicians is essential.
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Figure 1
Comparison of the annual cost of MDR-TB with that of malignant disease in South Korea*
*All costs demonstrated in this figure are the National health insurance programme covered annual costs converted to 2004 US dollars. Adapted from Kang, et al's study (7).
Table 1
Suggested regimens in patients with MDR-TB caused by M. tuberculosis resistant to isoniazid, rifampicin(and streptomycin)
ATS: American Thoracic Society, CDC: Centers for Diseases Control and Prevention, KATRD: Korean Association of Tuberculosis and Lung Diseases
*Injectables sensitive to specific strains.
†Oral bacteriostatic second-line antituberculosis agents; ethionamide, protionamide, cycloserine, terizidone, P-aminosalicylic acid (PAS), thioacetazone
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