Tuberculosis (TB) is a contagious disease that spreads when a person breathes in bacteria breathed out by an infected person. TB is mainly caused by Mycobacterium tuberculosis. About one third of the world’s population is infected with the latent form of the disease, and one-tenth of infected people become ill with active TB during their lifetimes. Symptoms differ depending on the area of the body infected. In pulmonary TB, common symptoms are a cough with sputum production (sometimes with blood), shortness of breath and chest pain. If properly diagnosed and treated, TB can be cured with six months of antibiotic therapy.
Multidrug-resistant TB (MDR-TB) is resistant to 2 of the most potent anti-TB drugs. It results from inadequate treatment of TB or poor airborne infection control in health care facilities and congregate settings. Treating MDR-TB is not only more expensive, it also requires about 2 years of treatment. Extensively drug-resistant TB (XDR-TB) is resistant to the main first- and second-line drugs, and therefore has very limited chances of cure.
Drug-resistant tuberculosis (DR-TB)
DR-TB is a key driver of the TB epidemic in the WHO European Region and one of the reasons that TB remains a major public health threat. Increased resistance to TB drugs particularly affects eastern European and central Asian countries.
The improvements achieved in treatment success in the Region are insufficient to eliminate TB by 2030 and reach the End TB and Sustainable Development Goal targets. If the current situation persists, the majority of new TB patients could be suffering from drug-resistant forms of the disease in a generation’s time. To address this challenge, the collaboration between health and other sectors should be increased; current tools and guidelines, such as rapid molecular tests and the 2019 WHO guidelines for treatment of DR-TB, should be implemented more systematically; and a people-centred approach to care should be adopted as a matter of priority.
What is DR-TB?
In many cases, TB can be cured with 6 months of antibiotic therapy, if properly diagnosed and treated. Incomplete or inadequate treatment can lead to the development of drug resistance, meaning forms of TB that do not respond to 1 or more antibiotics.
Multidrug-resistant TB (MDR-TB) is resistant to 2 of the most potent anti-TB drugs, isoniazid and rifampicin. Its treatment is not only more expensive, but also takes much longer. Today, only half of MDR-TB patients are treated successfully; the other half are at high risk of either not surviving or continuing to transmit the disease. The 2019 WHO guidelines for MDR-TB treatment recommend a shortened oral treatment that reduces side effects and facilitates therapy adherence. The guidelines also urge countries to scale up the introduction of new treatment regimens and new drugs, including the most efficient ones like bedaquiline.
Extensively drug-resistant TB (XDR-TB) is resistant to the main first- and second-line drugs, making curative treatment particularly challenging.
DR-TB in the WHO European Region
The eastern part of the WHO European Region has become the world’s DR-TB hot spot. Of the world’s 30 countries with the highest burden of MDR-TB, 9 are within the Region: Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Ukraine and Uzbekistan.