Spread of Resistance: Global Emergency

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The page below is a sample from the LabCE course Tracking Antibiotic-Resistant Tuberculosis. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Spread of Resistance: Global Emergency

The World Health Organization (WHO) reported two million deaths and a global emergency in 1993 resulting from the spread of TB.
  • Of the eight million patients who contracted the disease annually, 95% were in developing countries in Asia, Africa, and Latin America, where the threat continues. Attributed to poverty and slum-living conditions, TB is exacerbated by poor economic conditions.
  • Despite the availability of vaccines (for limited groups) and antimicrobial therapy, the cost is prohibitive for the patients in these developing regions.
  • In 1991, in an effort to curb the spreading pandemic, the WHO instituted the Direct-Observed Treatment Short Course (DOTS), the first solution to treating non-compliance by monitoring patients' adherence to drug therapy. Staffing was increased to implement DOTS, but many of the patients (who were homeless and/or IV drug abusers) were already living in a situation primed to precipitate further drug resistance that was difficult to access.
Emergence of extensively drug-resistant tuberculosis (XDR-TB)
By 2006, a threat greater than multidrug-resistant tuberculosis (MDR-TB) appeared, known as XDR-TB, which is untreatable by both first- and some second-line anti-tuberculosis drugs. The organism first appeared in India, then Africa in 2007, and later was confirmed by laboratories to include 91 countries. In 2016, a total of 8014 XDR-TB cases (6.2% of all MDR-TB cases) were identified.
Control measures
As a result of the advancing statistics, global health efforts by the WHO were again activated to set targets for eradicating all strains of TB by enhancing every available measure:
  • Increased DOTS, with a focus on HIV/AIDS patients with MDR- or XDR-TB (most effective measure)
  • Development of new vaccines and new molecular diagnostic methods
  • Patient advocacy, communication, and social mobilization
The effort continued with much success in developed countries. However, developing countries continued to suffer from the impact of TB disease. In 2020, it was estimated that the average cost (in U.S. dollars) for treating a patient with XDR-TB is $568,000, not including the productivity lost during treatment.