TY - JOUR T1 - Good news about a bad subject: scientific evidence to help defeat multidrug/extensively drug-resistant tuberculosis JF - European Respiratory Journal JO - Eur Respir J SP - 5 LP - 7 DO - 10.1183/09031936.00081714 VL - 44 IS - 1 AU - Giovanni Sotgiu AU - Mark Woodhead Y1 - 2014/07/01 UR - http://erj.ersjournals.com/content/44/1/5.abstract N2 - The good news about tuberculosis (TB) is that in the 29 reporting European Union/European Economic Area countries the number of incident TB cases is falling, with an average annual decline of 6% since 2011 [1]. The bad news is that, however you look at it, multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) remain a major clinical and public health problem worldwide, particularly in former Soviet Union countries and Central Asia [2–4]. Less than a quarter of the total estimated MDR-TB cases were actually diagnosed in 2012 [2], with dramatic consequences from an individual and a community perspective (i.e. increased morbidity, mortality and drug-resistant Mycobacterium tuberculosis transmission). It was estimated that 450 000 incident patients developed MDR-TB and 170 000 died from MDR-TB. More than half of such cases die, fail or stop taking treatment and only one in three cases in reporting countries completes the long treatment course (>20 months). The treatment success in the 2010 MDR-TB cohort was 48%, only 34 (31.8%) out of 107 countries reached a therapeutic success rate of at least 75%. About 9.6% of the MDR-TB cohort was XDR-TB. The direct and indirect costs are significant from a healthcare and a societal perspective [5, 6]. While the cost per case for drug-susceptible TB is estimated to be ∼€10 000, that for MDR-TB and for XDR-TB is estimated to be ∼€50 000 and €170 000, respectively [5]. The reasons for this increased cost are fairly obvious since successful management often requires a prolonged inpatient stay, exposure to a cocktail of multiple, expensive, usually less effective medications with frequent serious and unpleasant toxicities, to be taken under close medical and/or social supervision for many months (so-called directly observed therapy). That a significant … ER -