Stagg, HR;
Lipman, MC;
McHugh, T;
Jenkins, HE;
(2017)
Isoniazid resistant tuberculosis: a cause for concern?
International Journal of Tuberculosis and Lung Disease
, 21
(2)
pp. 129-139.
10.5588/ijtld.16.0716.
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Abstract
The drug isoniazid (INH) is a key component of global tuberculosis (TB) control programmes. It is estimated, however, that 16.1% of TB disease cases in former Soviet Union countries and 7.5% of cases outside of those settings have non-multidrug resistant (MDR) INH resistance. Resistance has been linked to poorer treatment outcomes, post-treatment relapse and death, at least for specific sites of disease. Multiple genetic loci are associated with phenotypic resistance, but the relationship between genotype and phenotype is complex. This restricts the use of rapid sequencing techniques as part of the diagnostic process to determine the most appropriate treatment regimens for patients. The burden of resistance also influences the usefulness of INH preventative therapy. Despite seven decades of the use of INH our knowledge in key areas - such as the epidemiology of resistant strains, their clinical consequences, whether tailored treatment regimens are required, and the role of INH resistance in fuelling the MDR -TB epidemic - is limited. The importance of non-MDR INH resistance needs to be re-evaluated both globally and by national TB control programmes.
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