European Respiratory Society

To the Editors:

The emergence of multidrug-resistant tuberculosis (MDR-TB, defined as in vitro resistance to isoniazid and rifampicin) 15 and extensively drug-resistant TB (XDR-TB, defined as in vitro drug resistance to isoniazid and rifampicin plus any fluoroquinolone and at least one of the injectable drugs: capreomycin, kanamycin or amikacin) represents a major threat to TB control at the global level 15.

In 2007, the World Health Organization (WHO) estimated a prevalence of 511,000 MDR-TB cases (with 150,000 deaths) and 50,000 XDR-TB cases (and 30,000 deaths) 1; 14 out of 19 high-MDR-TB burden territories are located in Former Soviet Union (FSU) countries 1.

XDR-TB is a manmade product, resulting, in essence, from clinical mismanagement of newly diagnosed pan-susceptible TB cases as well as MDR-TB cases 1, 2. There is evidence that suboptimal TB case management in parts of Europe contributes to the development of resistance to the XDR-TB defining drugs 47.

In spite of the growing amount of public awareness about TB drug resistance, the essential variables necessary to fully understand MDR-TB and XDR-TB are unfortunately not systematically collected, analysed and reported in published studies 2, 8. Although the international community is providing a rapid response to XDR-TB (formulation of an emergency plan 9; development of an instrument to support implementation and scale-up of national strategies and to assess programmatic needs 10), no standardised and comprehensive tool is available to survey the key factor responsible for the emergence of MDR-/XDR-TB: inappropriate TB case management.

The aim of this letter is to describe the process undertaken by the Tuberculosis Network European Trialsgroup (TBNET) in collaboration with the European Centre for Disease Prevention and Control (ECDC) to develop a standardised tool to survey MDR-/XDR-TB case management in the …