Antituberculosis drug resistance

Editor – Chapman's excellent editorial on tuberculosis (TB) drug resistance is a salutary reminder that this is likely to be an increasing problem (Clin Med October 2008 pp 478–9). It does, however, beg the question as to how a clinician is to manage such cases. The problem with drug resistant TB is that it is still relatively uncommon. Individual clinicians will therefore have little experience in managing cases. To help this situation, the Multi-Drug Resistant Tuberculosis (MDR-TB) Service has been established at the Cardiothoracic Centre in Liverpool and has been operational since 1 January 2008. The service has the support of the relevant professional bodies, including the British Infection Society, the Department of Health and the Health Protection Agency. Funding for this service has been provided by an unrestricted educational grant from Genus Pharmaceuticals. Essentially it is an electronically linked instant reaction expert group, which includes chest physicians, infectious disease physicians, paediatricians, public health specialists and microbiologists, who can give advice and direct management of cases across the country. It has already done so in some 26 cases from across the UK. By helping clinicians in the management of cases of drug resistant TB this national service offers our best hope in overcoming the increasing problem of drug resistance until new drugs become available. The Baltic states have operated a similar system for some years with good success in reducing their cases. The second function of the service is to collect data on all cases of multidrug resistant TB identified in the UK, with a view to developing a consensus on the most effective methods of treatment in this emerging area. The data collection will also help assess patient outcomes. The service can be contacted by email (MDRTBservice@lhch.nhs.uk) or by phone (0151 600 1427).