Multidrug-resistant tuberculosis (MDR-TB)

Multidrug-resistant tuberculosis (MDR-TB)

Tuberculosis Centre

Multidrug-resistant tuberculosis (MDR-TB)

Tuberculosis remains one of the scourges of our planet, especially in Africa. Fortunately drugs are available to treat this disease – that is, until the drugs no longer work! This is a state of affairs that already exists.

Drug resistance

When TB drugs no longer work, it threatens the progress made in TB care and control worldwide. How does this happen?

Antibiotics are designed to kill off the organisms that cause a disease. However, the antibiotics do this over a certain period of time and at certain dosage. When taken correctly, the antibiotics will destroy the bacteria that cause TB and the person will become well and will not infect anyone else.

When the person suffering from active TB does not take the antibiotics as they are prescribed, for example sometimes skipping a dose or not taking the antibiotics for the full course of treatment, the bacteria that cause TB are not destroyed. Clever as these bacteria are, they start to change or mutate into a different form that still causes TB but is resistant to the antibiotics that they’ve been exposed to, well knowing that next time they may not be so “lucky” as to escape the power of the same antibiotics.

Remember, due to not taking the antibiotics as prescribed, this person is still ill and can still infect another person, this time with a new form of TB. When he or she now needs treatment again, or when the person who was newly infected by this person needs treatment, the antibiotics that were originally prescribed no longer work because the bacteria have changed. In this way a drug-resistant TB has developed.

Other ways of treating the TB must now be found. Unfortunately, this vicious circle of events have continued, so that today we not only have drug-resistant TB, we also have multi-drug resistant TB (MDR-TB), extensively multi-drug resistant TB (XDR-TB), extremely drug-resistant TB (XXDR-TB) and even “total” drug-resistant TB (TDR-TB) in some areas. In the last case, it means that none of the medicines currently available has any effect towards curing TB in these persons. In early 2016, the North West Department of Health reported that only 65% of MDR-TB and 16% of XDR-TB cases in the province were treated successfully.

What’s to be done?

Given the fact that the treatment for TB is usually of six month duration and the medicines needed are inexpensive and very effective, while the treatment for MDR-TB takes 24 months and is 100 times more expensive, and patients experience more severe and unpleasant side-effects than with the first-line drugs, it is imperative that TB should be brought under control. A concerted effort should be undertaken by all governments and health care services. In addition:

  • First and foremost, every person taking medicines for TB must take them exactly as prescribed to prevent the emergence of drug resistance.
  • Secondly, new drugs must be development; unfortunately this may take years.
  • Further research regarding current medication must be done to determine whether changes to the regimen can be made which may still be effective.

In summary, the World Health Organisation says that “TB control programmes need to function effectively, and patients with TB need access to proper drugs and should adhere to treatment regimens …. It also is crucial to administer second-line TB drugs under very tightly controlled conditions so that they retain their potency.… The responsibility therefore jointly lies with individual patients as well as health authorities to ensure that TB drugs are taken correctly and responsibly to prevent XDR-TB.”


(Revised by M van Deventer)