Cases of tuberculosis caused by multidrug-resistant strains of Mycobacterium tuberculosis, that is to say resistant, at least to rifampicin and isoniazid, are characterized by the need to prescribe a combination of 3 -4 alternative drugs, which is a more expensive and toxic treatment. In multidrug-resistant tuberculosis, treatment failure and death are much more common.

Dr. M.D. Iseman and his colleagues retrospectively analyzed the results of 205 patients with multidrug-resistant tuberculosis (isolated strains of mycobacteria were resistant, on average, to 6 drugs) treated in 1984-1998. (second cohort), with results in 171 patients receiving treatment in 1973-1983. (first cohort) at the Jewish National Medical and Research Center in Denver. The results are published in American Journal of Respiratory and Critical Care Medicine.

Compared with the first cohort, patients treated in 1984-1998 showed an increase in the frequency of primary responses to treatment, determined by the results of at least three consecutive negative bacteriological studies of sputum over a period of at least 3 months (65% to 85%), the frequency of favorable long-term outcomes (56% to 75%) and the mortality coefficient associated with tuberculosis (22% to 12%). Fluoroquinolones have been shown to be the most optimal antimicrobial agents for the treatment of multidrug-resistant tuberculosis.

Removal of or significantly affected lung in patients with refractory tuberculosis caused by multidrug-resistant strains of mycobacterium has led to significant improvement, despite the fact that the operation for pulmonary tuberculosis is quite complicated. Surgical treatment complements medical treatment in its own right, but cannot completely replace it. However, it should be noted that operations should not be performed routinely in cases of tuberculosis, in which the response to treatment is slow.

Thus, resection of the affected lobe of the lung and therapy with fluoroquinolones considerably improves the microbiological and clinical results of tuberculosis caused by multidrug-resistant strains of mycobacteria. The high cost of this treatment technique prevents its widespread use.