Programmes and principles in treatment of multidrug-resistant tuberculosis

Lancet. 2004 Feb 7;363(9407):474-81. doi: 10.1016/S0140-6736(04)15496-2.


Multidrug-resistant tuberculosis (MDR-TB) presents an increasing threat to global tuberculosis control. Many crucial management issues in MDR-TB treatment remain unanswered. We reviewed the existing scientific research on MDR-TB treatment, which consists entirely of retrospective cohort studies. Although direct comparisons of these studies are impossible, some insights can be gained: MDR-TB can and should be addressed therapeutically in resource-poor settings; starting of treatment early is crucial; aggressive treatment regimens and high-end dosing are recommended given the lower potency of second-line antituberculosis drugs; and strategies to improve treatment adherence, such as directly observed therapy, should be used. Opportunities to treat MDR-TB in developing countries are now possible through the Global Fund to Fight AIDS, TB, and Malaria, and the Green Light Committee for Access to Second-line Anti-tuberculosis Drugs. As treatment of MDR-TB becomes increasingly available in resource-poor areas, where it is needed most, further clinical and operational research is urgently needed to guide clinicians in the management of this disease.

Publication types

  • Review

MeSH terms

  • Antibiotics, Antitubercular / therapeutic use
  • Antitubercular Agents / therapeutic use*
  • Clinical Protocols
  • Cohort Studies
  • Drug Resistance, Multiple, Bacterial
  • Drug Therapy, Combination
  • Global Health
  • Humans
  • National Health Programs
  • Retrospective Studies
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Tuberculosis, Multidrug-Resistant / prevention & control
  • Tuberculosis, Pulmonary / drug therapy*


  • Antibiotics, Antitubercular
  • Antitubercular Agents