Tuberculosis (TB)

Drug-resistant tuberculosis

A collage of images.

Anti-tuberculosis (TB) drug resistance is a major public health problem that threatens progress made in TB care and control worldwide. Drug resistance arises due to improper use of antibiotics in chemotherapy of drug-susceptible TB patients. This improper use is a result of a number of actions including, administration of improper treatment regimens and failure to ensure that patients complete the whole course of treatment. Essentially, drug resistance arises in areas with weak TB control programmes. A patient who develops active disease with a drug-resistant TB strain can transmit this form of TB to other individuals.

Global situation

Globally in 2016, there were an estimated 4.1% of new cases and 19% of previously treated cases with multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). Drug surveillance data show that of the estimated 600 000 people developed MDR-TB in 2016, and 240 000 people died. In spite of increased testing, the number of MDR/RR-TB cases detected only reached 153 000. In 2016, 8 000 patients with extensively drug-resistant TB (XDR-TB) were reported worldwide. To date, 123 countries have reported at least one XDR-TB case. On average, an estimated 6.2% of people with MDR-TB have XDR-TB.

Extensively drug-resistant tuberculosis (XDR-TB)

XDR-TB is a form of TB which is resistant to at least four of the core anti-TB drugs. It involves resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin, also known as multidrug-resistance (MDR-TB), in addition to resistance to any of the fluoroquinolones (such as ofloxacin or moxifloxacin) and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin).

fact buffet


558 000new cases of MDR/RR-TB estimated in 2017

Global situation


161 000patients with MDR/RR-TB detected and reported in 2017

MDR-TB factsheet 2018
pdf, 593kb


139 000patients were started on second-line treatment for MDR/RR-TB in 2017

Global tuberculosis report 2017

Key topics

Treatment of drug-resistant tuberculosis

Resistance to tuberculosis (TB) drugs is a formidable obstacle to effective TB care and prevention globally. Multidrug-resistant TB (MDR-TB) is multifactorial and fuelled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. Case management becomes difficult and the challenge is compounded by catastrophic economic and social costs that patients incur while seeking help and on treatment.

Multidrug-resistant tuberculosis surveillance

Surveillance of drug resistance in TB over the past two decades has informed and guided the response to the multidrug-resistant TB (MDR-TB) epidemic. The Global Project on Anti-TB Drug Resistance Surveillance is the oldest and largest project on surveillance of anti-microbial resistance in the world, reaching a milestone of 20 years of operations in 2014. Data on resistance to TB drugs are available for 144 countries, accounting for 95% of the world’s population and TB cases.

Guidance for implementation of PPM for management of drug-resistant TB

In most resource-poor countries with a high TB-burden, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health-care providers. Evidence suggests that failure to involve all care providers used by TB suspects and patients hampers case detection, delays diagnosis, leads to inappropriate and incomplete treatment, contributes to increasing drug resistance and places an unnecessary financial burden on patients.

News, events and meeting reports

  • 12-14 November 2019

    WHO guidelines on drug-resistant tuberculosis, 2019 Update

    The scope of the upcoming update of the WHO drug-resistant TB guidelines will focus on the use of a modified all-oral shorter MDR/RR-TB regimen (i.e. less than 12-month duration); use of a novel regimen combining pretomanid, bedaquiline and linezolid; use of bedaquiline for more than 6 months and its concurrent use with delamanid. To ensure transparency and neutrality in this guideline development process, the names and brief biographies of experts being considered for participation in this guideline development group meeting are disclosed for public notice.

  • 16-20 July 2018

    WHO treatment guidelines for rifampicin- and multidrug-resistant tuberculosis, 2018 update - GDG meeting

    WHO is convening a Guideline Development Group (GDG) meeting from 16 to 20 July 2018 to review the evidence for the treatment of MDR/RR-TB and make recommendations on the composition and duration of suitable treatment regimens. Systematic reviews and other newly emerging evidence will be used as per the WHO requirements for the development of the new policy.

  • February 2018

    Call for patient data

    WHO will convene a Guideline Development Group in July 2018 in order to assess the latest evidence and inform recommendations on the composition and duration of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) regimens. To aid this process, individual patient data (IPD) from clinical trials, as well as observational studies, will be analysed, preferably using anonymised individual patient data.

  • 28-29 June 2016

    Guideline Development Group (GDG) Meeting: Revision of the interim policy on bedaquiline for MDR-TB treatment and special session on delamanid use in children

    A Guidelines Development Group composed of tuberculosis experts was convened by WHO’s Global TB Programme to review data from recent studies of patients with drug-resistant TB, treated with bedaquiline and delamanid. The group met in Geneva on 28 and 29 June 2016 to review new data related to pharmacokinetics and pharmoacodynamics, effectiveness and safety, and to consider any relevant revisions to WHO interim policies (released in 2013 and 2014). The recommendations of the expert group on the use of delamanid in children (> 6) and for adolescents will inform upcoming WHO guidance revision. Further data on the use of bedaquiline are being collected and the evidence review is expected to be finalized in the second half of the year.

  • May 2016

    Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients

    New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

  • April 2016

    Updates on situation of drug-resistant TB in Papua New Guinea, with special emphasis on Daru Island

    This document provides an update on the progress made since May 2015 and WHO's position to further support the country's efforts