The primary aim of this report is to share survey and surveillance data on drug resistance in tuberculosis (TB). The data presented here are supplied largely by the programme managers who have led the work on surveys, but also by heads of reference laboratories and by principal investigators who may have been hired to assist the national TB programmes with the study. We thank all of them, and their staff, for their contributions. The World Health Organization/International Union Against Tuberculosis and Lung Disease (WHO/UNION) Global Project on Anti-Tuberculosis Drug Resistance Surveillance is carried out with the financial backing of United States Agency for International Development (USAID) and Eli Lilly and Company as part of the Lilly multidrug resistant (MDR)-TB Partnership. Drug resistance surveys were supported financially by the Dutch Government, the Global Fund, Japan International Cooperation Agency (JICA), Kreditanstalt für Wiederaufbau (KfW Entwicklungsbank), national TB programmes and USAID). The Supranational Reference Laboratory Network provided the external quality assurance, as well as technical support to many of the countries reporting. Technical support for surveys was provided by the Centers for Disease Control and Prevention (CDC), JICA, the Royal Netherlands Tuberculosis Association (KNCV), and WHO. Data for the WHO European Region were collected and validated jointly with EuroTB (Paris) — a European TB surveillance network funded by the European Commission.
This global TB report was produced by a core team of 18 people: Laura Anderson, Hannah Monica Dias, Dennis Falzon, Katherine Floyd, Inés Garcia Baena, Christopher Gilpin, Philippe Glaziou, Yohhei Hamada, Avinash Kanchar, Irwin Law, Christian Lienhardt, Andrew Siroka, Charalambos Sismanidis, Lana Syed, Hazim Timimi, Wayne van Gemert, Diana Weil and Matteo Zignol. The team was led by Katherine Floyd. Overall guidance was provided by the Director of the WHO Global TB Programme, Mario Raviglione.
Sir John Crofton (1912–2009), whose pioneering work in the use of combination drug therapy for the treatment of tuberculosis has resulted in countless lives saved
“The greatest disaster that can happen to a patient with tuberculosis is that his organisms become resistant to two or more of the standard drugs. Fortunately we can prevent the emergence of drug resistance in virtually all cases if we take enough trouble to ensure that the best drug combinations are prescribed and that the patient takes them as directed. It is often not realized how venial a sin can result in ultimate disaster. It might be suggested that giving a risky combination of drugs, or even giving a drug alone, will not matter if it is only for a short time. It is true that it may not matter in a number of patients, but in some it can matter very much and may make all the difference between survival and death.
The development of drug resistance may be a tragedy not only for the patient himself but for others. For he can infect other people with his drug-resistant organisms. In such patients the disease would not be sensitive to the drug in question. A recent survey by the Medical Research Council (Fox et al., 1957) in various clinics all over the country has shown that no less than 5% of newly diagnosed patients were infected with organisms resistant to at least one of the three main drugs. If physicians come to apply thoroughly the present knowledge about preventing drug resistance, this percentage should steadily diminish”.
From Chemotherapy of pulmonary tuberculosis, by John Crofton, read to a plenary session at the Annual Meeting of the British Medical Association, Birmingham, England, 1958 (British Medical Journal, 1959, 5138(1):1610–1614).
This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.
This document was prepared for the World Health Organization (WHO) Global Malaria Programme by Amy Barrette and Pascal Ringwald and was reviewed by Rick Fairhurst (National Institute of Allergy and Infectious Diseases) Arjen Dondorp (Mahidol–Oxford Tropical Medicine Research Unit); Patrick ; Kachur, John MacArthur, Laurence Slutsker (Malaria Branch, Centers for Disease Control and Prevention); Christopher Plowe (University of Maryland); Christopher Dye, Kamini Mendis, Robert Newman, Peter Olumese, Jackson Sillah and Mariam Warsame (WHO). The Global Malaria Programme wishes to thank the ministries of health, nongovernmental organizations, pharmaceutical companies, public private partnerships, research institutes, subregional networks and WHO regional offices that kindly shared their data. Financial support for the preparation of this document and the WHO global database on antimalarial drug efficacy was provided by the Bill & Melinda Gates Foundation and the United States Agency for International Development
The Stop TB Department of the World Health Organization gratefully acknowledges the members of the Guidelines Group (listed in Annex 6), including Jeremiah Muhwa Chakaya, the Chairperson. Richard Menzies (McGill University, Montreal, Canada), Karen Steingart and Phillip Hopewell (University of California, San Francisco, USA) and Andrew Nunn and Patrick Phillips (British Medical Research Council) led the teams that compiled, synthesized and evaluated the evidence underlying each recommendation. Suzanne Hill and Holger Schünemann facilitated the meeting of the Guidelines Group. Useful feedback was obtained from the External Review Group (also listed in Annex 6). Additional feedback and support were provided by the Guidelines Review Committee (Chair, Suzanne Hill; Secretariat, Faith McLellan). Publication of the guidelines was supported in part by a financial contribution from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The document was prepared by Sarah Royce and Malgorzata Grzemska. Dorris Ortega provided secretarial support.
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18–30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 2006;55[No. RR–11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.