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Extra info for Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary
2007). This level of resistance severely limits treatment options based on the WHO guidelines for the programmatic management of drug-resistant TB, which require treatment with at least four effective drugs. Alexander Sloutsky of the University of Massachusetts provided additional evidence for the potential emergence of totally resistant TB. Data from the Central Tuberculosis Research Institute in Moscow demonstrate the existence of one case of total drug resistance as early as 1997, with three additional cases in the following year.
In addition, the MDR TB rate in Mozambique, which introduced rifampicin at the same time as Gambia, is 10 times higher than that in Gambia. Ben Amor further argued that countries identified as having the capability to conduct drug resistance surveys (WHO, 1997, 2000, 2004, 2008b) are more likely to have a well-functioning national TB program, laboratory structure, and transport network and therefore lower rates of MDR TB than those countries without these capabilities. Old Data Ben Amor discussed the credibility of the limited data that are being collected in Africa, arguing that there is compelling evidence that these data are misleading.
SOURCE: Zintl, 2008 (based on unpublished data from GLC Secretariat, Geneva 2008). Transmission of XDR TB Jeffrey Drazen of the New England Journal of Medicine noted that drug-resistant strains of other diseases typically are not as resilient as drugsusceptible strains and therefore tend to die out. By contrast, in the MDR TB epidemic that occurred in New York City in the early 1990s, which affected mainly HIV-infected persons, the strains were readily transmissible. The recent experience in Africa and elsewhere provides further evidence of this phenomenon.
Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary by Institute of Medicine