Preventing multidrug resistant tuberculosis: the dawn of a new era

Multidrug resistant tuberculosis (MDR-TB) remains a global health threat and accounts for a quarter of deaths due to antimicrobial resistance. Individuals infected with MDR-TB are at risk of progressing to TB disease. Treatment of drug-resistant TB infection to prevent progression to disease and avert the associated morbidity and mortality is a global priority. Randomised evidence to inform TB preventive treatment guidelines have been lacking. Two recently completed trials provide the first randomized evidence that treatment of household contacts exposed to patients with MDR-TB with daily levofloxacin for six months is safe and efficacious in preventing TB. Based on these results, the World Health Organization updated its TB preventive treatment guidelines to make a strong recommendation for use of levofloxacin for six months in MDR-TB exposed contacts. Novel, shorter regimens in development will usher in a new era for the treatment of MDR-TB infection if shown to be safe and efficacious.