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Multi-Drug-Resistant Pulmonary Tuberculosis

A case of multiple-drug-resistant pulmonary tuberculosis (TB) is presented. The patient's refusal to complete a course of drug therapy culminated in numerous relapses, treatment failures, and finally, death. Noncompliant drug behavior is probably the major cause of treatment failure. Supervised intermittent and short-course regimens can be utilized when patients demonstrate poor cooperation in self-medication programs. Resistance to first-line agents complicates retreatment of TB. Drug selection in these cases should be based on the results of sensitivity studies, and effective regimens frequently require the use of more toxic secondary agents. Although published guidelines for appropriate treatment of TB are available, inappropriate therapy continues to occur. Resistant organisms can be transmissible and virulent, and patients infected with them may serve as infector pools that produce new cases of primary resistance. The control of resistant TB depends on our ability to identify these individuals and to insure that they comply with effective drug regimens.