The Race Against Drug-Resistant Tuberculosis

A new treatment for multidrug-resistant tuberculosis (MDR-TB) has shown promising results in safety and efficacy but is already encountering resistance, raising concerns about the global fight against antimicrobial resistance.

Global burden of tuberculosis and the rise of resistance

Tuberculosis (TB) remains a significant global health challenge, affecting over 10 million people annually and causing 1.25 million deaths. MDR-TB presents an even greater threat, particularly in regions with high TB burdens such as India, Central Asia and Southern Africa. Traditional MDR-TB treatments are lengthy, costly and often associated with severe side effects.

In 2022, the World Health Organization (WHO) approved a six-month treatment regimen called BPaL(M), offering new hope for patients. However, the emergence of resistance to this regimen has highlighted the ongoing challenges in managing TB.

“While this new regimen is a game changer for patients suffering from MDR-TB, we knew that it will be difficult to outsmart Mycobacterium tuberculosis, the bacteria causing TB,”

Sébastien Gagneux

A study led by Swiss Tropical and Public Health Institute (Swiss TPH) and the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia, published in the New England Journal of Medicine, examined the rise of resistance to BPaL(M). Researchers analyzed the genomes of nearly 90,000 Mycobacterium tuberculosis strains from Georgia and 26 other countries. Among these, 514 strains resistant to both traditional and new TB drugs were identified.

Alarmingly, 28% of these resistant strains were traced to direct transmission between patients, demonstrating the potential for resistance to spread rapidly. While the overall number of cases remains low, this pattern underscores the importance of swift intervention to prevent further transmission.

“The good news is that the total number of these cases is still low. However, the fact that more than a quarter of these highly drug-resistant cases are due to patient-to-patient transmission, only two years after WHO endorsed the new regimen, is worrying,”

Galo A. Goig

Importance of diagnostics and infection control

To address the challenge of drug resistance, the researchers emphasize the need for enhanced diagnostics, infection control and surveillance systems. Combining the deployment of new regimens with these measures is critical to preserving the efficacy of TB treatments.

“These new drugs have taken many years to develop, and to prevent drug resistance from emerging, it is essential to combine the deployment of these new regimens with robust diagnostics and surveillance systems,”

Chloé Loiseau

Implications for antimicrobial resistance

The findings also serve as a stark reminder of the broader threat of AMR. The rapid emergence and transmission of resistant TB strains highlight the urgency of staying ahead in the race between drug development and bacterial evolution. Without robust strategies, the global community risks entering a "post-antibiotic era" for TB and other infectious diseases.

Reference: Goig GA, Loiseau C, Maghradze N, et al. Transmission as a key driver of resistance to the new tuberculosis drugs. N Engl J Med. 2025;392(1):97-99. doi: 10.1056/NEJMc2404644

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