Priorities in addressing rifampicin resistant TB

Progress in testing and trial design are needed Rifampicin is a critical component of tuberculosis (TB) treatment regimens. Recent positive developments in rifampicin resistant TB—the emergence of new drugs and treatment regimens, declines in incidence, and improvements in the proportion of people being diagnosed and successfully treated—are now threatened by the rapid emergence of resistance to other critical drugs and by poor political choices.1 Failure to diagnose rifampicin resistance, and rifampicin resistant TB with additional resistance to critical second line drugs, in a timely manner, risks poor clinical outcomes, acquired resistance, and transmission of resistant strains.23 There are two types of drug susceptibility tests—genotypic and phenotypic. Genotypic tests identify genetic mutations that cause drug resistance. Phenotypic tests identify resistance by observing the organism’s ability to grow in the presence of drugs. Some rapid drug susceptibility tests can be performed in the clinic or a local laboratory (near patient), reducing delays in providing results to clinicians. In recent years, rapid near patient drug susceptibility testing has become more widely available. In Peru, rapid near patient phenotypic drug susceptibility testing to multiple critical drugs was rolled out successfully, with associated improvements in clinical outcomes.4 …