Treatment failure and resistance amplification are common among patients with rifampin-resistant tuberculosis (TB).Drug susceptibility testing (DST) for second-line here drugs is recommended for these patients, but logistical difficulties have impeded widespread implementation of second-line DST in many settings.To provide a quantitative perspective on the decision to scale up second-line DST, we synthesize literature on the prevalence of second-line drug resistance, the expected clinical and epidemiologic benefits of using second-line DST to ensure that patients with rifampin-resistant TB receive effective regimens, and the costs of implementing (or not implementing) second-line DST for all individuals diagnosed with rifampin-resistant TB.We conclude that, in roneverhart.com most settings, second-line DST could substantially improve treatment outcomes for patients with rifampin-resistant TB, reduce transmission of drug-resistant TB, prevent amplification of drug resistance, and be affordable or even cost-saving.
Given the large investment made in each patient treated for rifampin-resistant TB, these payoffs would come at relatively small incremental cost.These anticipated benefits likely justify addressing the real challenges faced in implementing second-line DST in most high-burden settings.