Antimicrobial resistance - Tuberculosis

Antimicrobial resistance develops when treatment regimens are not properly administered or adhered to. It can also occur as a result of biological variations in drug uptake or substandard drugs. Multidrug-resistant (MDR) TB entails resistance to at least two of the most effective TB drugs, isoniazid and rifampicin. Extensively drug-resistant (XDR) TB includes additional resistance to any fluoroquinolone, and to any of the second-line injectable TB drugs (amikacin, capreomycin and kanamycin). Treatment of M(X)DR TB lasts at least 18 months, with intake of at least five drugs at a time, involving a significantly higher risk for adverse drug effects. Costs of treatment for M(X)DR TB are much higher than costs of treatment for drug-susceptible TB.

European context

M(X)DR TB poses a serious challenge for eradicating TB in Europe. The notification rate of MDR TB in the EU/EEA region has remained unchanged and is around 0.3 per 100 000 population, with roughly 1 300 cases reported each year. Around 20% of these cases have XDR TB.

In the EU/EAA, only about 35% of MDR TB patients have a successful treatment outcome; over half of the patients die, fail to respond to treatment or stop treatment, increasing the risk of developing XDR TB, which has even worse treatment outcomes. These rates are far below the 75% treatment success target defined by the Tuberculosis action plan for the WHO European Region 2016–2020.

A qualitative study Healthcare system factors influencing treatment results of patients with multidrug-resistant tuberculosis in four EU countries has determined key factors for achieving good treatment results in patients with MDR TB across the EU/EEA:

  • Timely diagnosis of drug-resistant TB through implementation of rapid molecular drug-susceptibility testing in accordance with national guidelines.
  • Financial systems favourable for the treatment and support of multidrug-resistant TB without financial barriers for patients.
  • Intersectoral collaboration that addresses patients’ emotional and social needs as well as their clinical needs, such as treatment regimen, co-management of substance dependencies and other co-morbidities.
  • Motivated and devoted healthcare workers with sufficient mandate and means to support patients.
  • Cross-border management of multidrug-resistant TB cases with the development of collaborative mechanisms for a continuum of care between countries, including social support and reporting of treatment results.

Data

Treatment success as of 2017 in MDR TB

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News

Every hour 30 people are diagnosed with tuberculosis in the European Region. It’s time to make TB a disease of the past

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Peer-Reviewed Publication

European Union standard for tuberculosis care on treatment of multidrug-resistant tuberculosis following new World Health Organization recommendations

Nov 2018

Peer-Reviewed Publication

'treatment is of primary importance, and social assistance is secondary': A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia

Oct 2018

Publication

European Union Standards for Tuberculosis Care - 2017 update

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Publication

Multidrug-resistant tuberculosis in migrants, multi-country cluster - 3rd update, 13 April 2017

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Publication

Rapid risk assessment: multidrug-resistant tuberculosis in migrants, multi-country cluster - 2nd update, 27 March 2017

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Publication

Multidrug-resistant tuberculosis in migrants, multi-country cluster, first update 19 Dec 2016

risk assessment -

Publication

Tuberculosis surveillance and monitoring in Europe, 2018

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Publication

Communicable disease threats report, 9-15 April 2017, week 15

surveillance report -

Publication

Communicable disease threats report, 2–8 April 2017, week 14

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Publication

Tuberculosis surveillance and monitoring in Europe, 2017

surveillance report -

Publication

Molecular typing for surveillance of multidrug-resistant tuberculosis in the EU/EEA

surveillance report -

Peer-Reviewed Publication

European Union standard for tuberculosis care on treatment of multidrug-resistant tuberculosis following new World Health Organization recommendations

Nov 2018

Peer-Reviewed Publication

'treatment is of primary importance, and social assistance is secondary': A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia

Oct 2018

Peer-Reviewed Publication

Screening of migrants for tuberculosis identifies patients with multidrug-resistant tuberculosis but is not sufficient

Aug 2018

Peer-Reviewed Publication

Linkage to care is important and necessary when identifying infections in migrants

Jul 2018

Peer-Reviewed Publication

Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis

Jul 2018

Data

Treatment success as of 2017 in MDR TB

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Data

Tuberculosis situation in Europe [2014 data]

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Data

Reported TB cases in the EU/EEA, 2008-2012

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Data

Reported MDR XDR TB cases in the EU/EEA, 2012

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Data

The burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB

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