Abstract

The emergence of multidrug-resistant tuberculosis (MDR-TB, defined as in vitro resistance to isoniazid and rifampicin) 1–5 and extensively drug-resistant TB (XDR-TB, defined as in vitro drug resistance to isoniazid and rifampicin plus any fluoroquinolone and at least one of the injectable drugs: capreomycin, kanamycin or amikacin) represents a major threat to TB control at the global level 1–5.
In 2007, the World Health Organization (WHO) estimated a prevalence of 511,000 MDR-TB cases (with 150,000 deaths) and 50,000 XDR-TB cases (and 30,000 deaths) 1; 14 out of 19 high-MDR-TB burden territories are located in Former Soviet Union (FSU) countries 1.
XDR-TB is a manmade product, resulting, in essence, from clinical mismanagement of newly diagnosed pan-susceptible TB cases as well as MDR-TB cases 1, 2. There is evidence that suboptimal TB case management in parts of Europe contributes to the development of resistance to the XDR-TB defining drugs 4–7.
In spite of the growing amount of public awareness about TB drug resistance, the essential variables necessary to fully understand MDR-TB and XDR-TB are unfortunately not systematically collected, analysed and reported in published studies 2, 8. Although the international community is providing a rapid response to XDR-TB (formulation of an emergency plan 9; development of an instrument to support implementation and scale-up of national strategies and to assess programmatic needs 10), no standardised and comprehensive tool is available to survey the key factor responsible for the emergence of MDR-/XDR-TB: inappropriate TB case management.

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