A Balancing Act: Efflux/Influx in Mycobacterial Drug Resistance

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Abstract
Since the discovery of the tubercle bacillus by Robert Koch in 1882 (110), a greater understanding of the dynamics and survival mechanisms of this pathogen has led to more ques- tions than answers. Despite stringent control strategies and many advances in our knowledge of the epidemiology of tu- berculosis (TB) and the biology of the causative agent Myco- bacterium tuberculosis, TB still remains one of the most common and deadly infectious diseases worldwide. The emer- gences of multidrug-resistant TB (MDR-TB) (with resistance to at least the first-line drugs isoniazid (INH) and rifampin (rifampicin) (RIF)) (39) and extensively drug-resistant TB (XDR-TB) (with additional resistance to a fluoroquinolone (FQ) and any one of the injectable drugs kanamycin (KAN), amikacin (AMI), and capreomycin (CAP)) (43, 67) are a major

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