Drug-resistant tuberculosis: is India ready for the challenge?

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Abstract
### Summary box Tuberculosis (TB) kills close to half a million Indians every year.1 Additionally, a million ‘missing’ undiagnosed or inadequately diagnosed cases go unnotified annually.2 Not surprisingly, drug-resistant tuberculosis (DR-TB) is a significant problem, and India now has the most number of cases of multidrug-resistant tuberculosis (MDR)-TB in the world, contributing one-fourth of the global burden.1 The treatment of MDR-TB requires the use of toxic drugs, is long and expensive and has substantially lower success rates than for drug-sensitive TB.1 In this commentary, we review the burden of drug resistance in India considering recent data from India3 and discuss areas of focus necessary to combat DR-TB. Globally, 4.1% of new TB cases are reported to be MDR.1 Concordant with previous surveys, the First National Anti-Tuberculosis Drug Resistance survey conducted by the Indian Government in collaboration with the World Health Organization (WHO) and the United States Agency for International Development (USAID) showed that close to 23% of new cases have resistance to any drug with MDR-TB detected in 3%.3 Monoresistance to rifampin was not seen and resistance to isoniazid (INH) was highest (any 11%, monoresistance 4%), followed by resistance to pyrazinamide (any 7%, monoresistance 4%) and …

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