Loddenkemper, Robert and Sotgiu, Giovanni and Mitnick, Carole D. (2012) Cost of tuberculosis in the era of multidrug resistance: will it become unaffordable? European Respiratory Journal, Vol. 40 (1), p. 9-11. eISSN 1399-3003. Article.
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In 1905, Robert Koch ended his Nobel Lecture on ‘‘The current state of the struggle against tuberculosis’’ with the optimistic sentence: ‘‘If the work goes on in this powerful way, then the victory must be won’’. At the end of the 1970s and the beginning of the 1980s, many believed that tuberculosis (TB) was nearly vanquished. Now, more than 100 years after Koch’s Nobel Lecture, TB has emerged as an even greater public health problem, mainly for two reasons: coinfection with HIV and the development of complex mycobacterial drug resistance patterns. The World Health Organization (WHO) estimates that of the 8.8 million new cases in 2010, ~3% were caused by multidrugresistant (MDR) strains of Mycobacterium tuberculosis, defined as resistance to at least the two most powerful anti-TB drugs, isoniazid and rifampicin. Furthermore, ~30,000 cases were thought to be due to extensively drug-resistant (XDR) strains, defined as MDR plus resistance to any fluoroquinolone and at least one second-line injectable anti-TB drug (amikacin, capreomycin or kanamycin). The estimated prevalence of MDR-TB in new and previously treated cases in 2010 was 650,000 worldwide. MDR- and XDR-TB are man-made phenomena that emerge as a result of inadequate treatment of TB and/or poor airborne infection control in healthcare facilities and congregate settings. To resolve the epidemic of MDR-TB, several interventions are needed urgently: rapid case detection, proper infection control, timely access to quality-assured first- and second-line drugs within appropriate regimens, capacity-building to deliver treatment effectively, standardised recording and reporting of treatment outcomes within effective national TB control programmes, and the commitment of national governments.
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