Tuberculosis, Lung Infections, and Respiratory Care

Drug-Resistant Tuberculosis and Treatment Strategies

Drug-resistant tuberculosis (DR-TB) remains one of the most serious challenges in global health, threatening progress toward TB elimination. It occurs when Mycobacterium tuberculosis develops resistance to one or more of the key first-line anti-TB drugs, most commonly isoniazid and rifampicin. The most severe forms include multidrug-resistant TB (MDR-TB), resistant to at least isoniazid and rifampicin, and extensively drug-resistant TB (XDR-TB), which is resistant to additional second-line drugs.

Drug resistance primarily develops due to inadequate or incomplete treatment—such as irregular medication use, incorrect prescriptions, or poor drug quality—which allows the bacteria to survive and adapt. Genetic mutations in M. tuberculosis confer resistance by altering drug targets, reducing drug uptake, or enhancing drug metabolism. The spread of resistant strains through person-to-person transmission further complicates control efforts. Ongoing research focuses on developing shorter, safer, and more effective regimens, exploring host-directed therapies, and enhancing vaccine development to prevent both drug-susceptible and resistant TB. Global collaboration, equitable access to new drugs, and strengthening health systems are critical to overcoming the threat of drug-resistant tuberculosis.