Journal
CLINICAL INFECTIOUS DISEASES
Volume 65, Issue 7, Pages 1206-1211Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cix486
Keywords
tuberculosis; drug resistance; microbial; microbial sensitivity tests
Categories
Funding
- Bill and Melinda Gates Foundation
- Wellcome Trust
- South African Medical Research Council Career Development Fellowship
- European and Developing Countries Clinical Trials Partnership as part of the EDCTP2 programme - European Union
- Royal Society
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A novel, shorter-course regimen for treating multidrug-resistant (MDR) tuberculosis was recently recommended by the World Health Organization. However, the most appropriate use of drug susceptibility testing (DST) to support this regimen is less clear. Implementing countries must therefore often choose between using a standardized regimen despite high levels of underlying drug resistance or require more stringent DST prior to treatment initiation. The former carries a high likelihood of exposing patients to de facto monotherapy with a critical drug class (fluoroquinolones), whereas the latter could exclude large groups of patients from their most effective treatment option. We discuss the implications of this dilemma and argue for an approach that will integrate DST into the delivery of any novel antimicrobial regimen, without excessively stringent requirements. Such guidance could make the novel MDR tuberculosis regimen available to most patients while reducing the risk of generating additional drug resistance.
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