Multidrug-resistant tuberculosis is formally defined as an active infection by Mycobacterium tuberculosis exhibiting confirmed resistance to the two most potent first-line anti-tuberculosis medications, isoniazid and rifampicin [1][2]. Resistance typically originates from specific chromosomal mutations, such as alterations in the rpoB and katG genes, which arise following inconsistent drug exposure or monotherapy [2]. When additional resistance extends to fluoroquinolones or other critical second-line agents, the infection may be classified under broader drug-resistant or extensively drug-resistant categories [3].
Disease overview
BacterialMultidrug-resistant tuberculosis
多重耐药结核病
Evidence-backed informationEN 5/7 applicable sections · ZH 5/7 applicable sectionsUpdated Sep 3, 2026
Multidrug-resistant tuberculosis represents a bacterial infection caused by Mycobacterium tuberculosis strains that have developed resistance to at least two first-line antimicrobial agents, specifically isoniazid and rifampicin [1][2]. This condition constitutes a major global public health burden, disproportionately affecting regions such as Eastern Europe, Russia, Asia, and sub-Saharan Africa while consuming a disproportionate share of national tuberculosis control budgets [3]. The disease emerges primarily through genetic mutations triggered by incomplete or inappropriate therapeutic regimens, resulting in prolonged illness and elevated mortality compared to drug-susceptible counterparts [4].
Read the full clinical and epidemiological profile6
Active infection manifests as a systemic illness characterized by a protracted clinical course, accompanied by significantly higher morbidity and mortality rates than standard tuberculosis [4]. Patients frequently experience substantial pulmonary deterioration and long-term respiratory impairment following disease resolution [3]. The underlying pathophysiology involves persistent bacterial replication driven by genetic adaptations that neutralize conventional pharmacological interventions, though specific symptomatic presentations align with typical pulmonary tuberculosis pathology [1][2].
Multidrug-resistant tuberculosis cases have been documented across all surveyed countries, with concentrated burdens observed in Eastern Europe, Russia, Asia, and sub-Saharan Africa [1]. The infection serves as a predominant contributor to global infectious disease mortality, with delayed detection methods potentially exacerbating case incidence [2]. Regional variations are pronounced, as evidenced by resistance rates reaching nearly fifty percent among previously treated cohorts in specific humanitarian settings like Somalia [1]. Outbreaks tend to cluster within environments featuring compromised host immunity, particularly among populations living with HIV, where transmission dynamics can accelerate despite generally attenuated bacterial fitness [1].
Multidrug-resistant tuberculosis spreads primarily through airborne respiratory droplets expelled during coughing by individuals with active pulmonary disease [1]. The infectious potential of these resistant strains remains comparable to that of drug-susceptible variants, maintaining high transmissibility within exposed communities [3]. Secondary spread accelerates markedly in environments where immune defenses are impaired, facilitating rapid colonization among vulnerable contacts [1].
Public health strategies emphasize the strict adherence to standardized multi-drug therapeutic regimens to prevent the emergence of resistant bacterial strains [1]. International monitoring frameworks, such as those coordinated by regional disease prevention authorities, utilize targeted screening of high-risk migrant populations to assess transmission threats to local communities [1]. Comprehensive prevention protocols further require integrated management approaches that address pathogenesis, diagnostic accuracy, and therapeutic consistency to mitigate future resistance development [3].
- 1Wikipedia contributors. Multidrug-resistant tuberculosis - Wikipedia [Internet]. Wikipedia. cited 4 Sept 2026.Available from: https://en.wikipedia.org/wiki/Multidrug-resistant_tuberculosis
- 2Wulandari DA et al. Multidrug-resistant tuberculosis. Clin Chim Acta. 2024 Jun 1. PMID: 38697459. doi: 10.1016/j.cca.2024.119701.PubMed: https://pubmed.ncbi.nlm.nih.gov/38697459/
- 3Dheda K et al. Multidrug-resistant tuberculosis. Nat Rev Dis Primers. 2024 Mar 24. PMID: 38523140. doi: 10.1038/s41572-024-00504-2.PubMed: https://pubmed.ncbi.nlm.nih.gov/38523140/
- 4Lange C et al. Management of drug-resistant tuberculosis. Lancet. 2019 Sep 14. PMID: 31526739. doi: 10.1016/S0140-6736(19)31882-3.PubMed: https://pubmed.ncbi.nlm.nih.gov/31526739/
- A15-A19
- 1B10
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