Causes for Drug-resistant Tuberculosis

Drug resistance is caused by a genetic mutation that makes the drug ineffective against the mutant bacilli.

The causes of drug-resistant TB can be enumerated as follows: 

1. Providers/ Programme Related Causes:

• Inadequate or poorly administered TB treatment regimen
• Unavailability or poor quality of anti-TB drugs
• Poor monitoring of TB treatment
• Delay in detection and management of DR-TB

2. TB Patient/ Host Related Causes:

• Clinical characteristics of TB patients leading to suboptimal drug levels in blood (e.g. Malabsorption syndrome)
• Irregular anti-TB treatment due to any reason (e.g. socio-economic barriers, substance abuse, Adverse Drug Reactions (ADRs), psychological and other factors)

There are two principal causal pathways leading to the development of drug-resistant TB:

• Primary drug resistance: It means that a person has been infected with a drug-resistant TB strain.​

• Acquired (Secondary) drug resistance: It is the result of inadequate, incomplete or poor treatment quality that allows the selection of mutant resistant strains. 

   

Resources

• Guidelines for PMDT in India, 2021.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis.

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