Management of multidrug‐resistant tuberculosis in the Asia–Pacific region

Multidrug‐resistant tuberculosis (MDR‐TB) with bacillary resistance to at least isoniazid and rifampicin in vitro is a worldwide phenomenon. Hotspots of the disease are found scattered in different continents. Preventing its development through good tuberculosis control programmes with well functioning directly observed therapy—short course (DOTS) strategy is of paramount importance. However, with established MDR‐TB, treatment with alternative and specific chemotherapy is necessary to achieve a favourable outcome. Such an approach on a programmatic basis is currently known as the ‘DOTS‐Plus’ strategy. Second‐line drugs utilised in the treatment of MDR‐TB are generally less potent and more toxic, perhaps with the notable exceptions of some fluoroquinolones and injectable agents. Surgery has a distinct adjunctive role for the management of MDR‐TB in selected patients. The emergence of extensively drug‐resistant tuberculosis (XDR‐TB), that is MDR‐TB with additional bacillary resistance to the fluoroquinolones and injectable second‐line drugs, poses a significant challenge to global health, as the disease has currently a low cure rate and high mortality. In order to combat XDR‐TB, strengthening of the DOTS and DOTS‐Plus programmes is mandatory, especially in the face of surging HIV infection. Furthermore, exceedingly intense efforts need to be focused on the development of new drugs with potent bactericidal and sterilising activities, alongside good tolerance profiles, and above all, affordability for communities worldwide.