Doomsday postponed? Preventing and reversing epidemics of drug-resistant tuberculosis

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Abstract
Despite bleak news on the spread of drug-resistant tuberculosis (TB) strains in Eastern Europe and southern Africa, there are signs that drug-resistant TB can be controlled. Evidence suggests that good control programmes, using the current suite of anti-TB drugs, can cut the number of multiply resistant TB cases even more quickly than drug-sensitive cases. Extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis, now known to be present in 50 countries, heighten the threat posed by untreatable and fatal human tuberculosis (TB). To combat epidemics of drug-resistant TB, it is vital to understand why some resistant strains have greater reproductive fitness — a greater propensity to spread — than drug-susceptible strains. If public health malpractice has been a more important determinant of reproductive success than genetic mechanisms, then improved diagnosis and treatment could keep the frequency of resistant strains among TB cases low in any population. Recent data suggest that national TB control programmes that use existing drugs efficiently can postpone and even reverse epidemics of multidrug-resistant TB, although the effect of such programmes on XDR strains remains largely unknown.