One in 10 tuberculosis cases in China is multidrug resistant

About a million new cases of tuberculosis are detected in China each year. A nationally representative survey of about 4 000 people with tuberculosis showed that, in 2007, one- third of new cases as well as more than a half of previously treated cases had tuberculosis resistant to at least one of the first-line drugs – isoniazid, rifampicin, ethambutol, and streptomycin. One in 10 people had multidrug-resistant tuberculosis – where the organism is resistant to at least isoniazid and rifampicin – and 1 in 120 was also resistant to second-line drugs ofloxacin and kanamycin. In most cases, the organism was already resistant at the point of infection.

Drug-resistant tuberculosis is on the rise worldwide, says a linked editorial. If the epidemic is to be contained, diagnosis and treatment need to be improved. Global policies already call for testing microbial resistance in all patients, but most programmes still focus only on patients considered to be at high risk.

New drugs, such as delamanid and bedaquiline, may soon be approved for second-line treatment on the basis of placebo-controlled trials. However, we don’t know whether they can be given concurrently or how best to incorporate them into existing regimens.

Zhao Y, et al. N Engl J Med 2012;366(23):2161-2170.