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MDR-TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period because they start to feel better, health workers prescribe the wrong drugs or the wrong combination of drugs, or the drug supply is unreliable.

People they infect will acquire the same drug-resistant strain. When drug treatment stops, the bacteria build up resistance to medication, reducing options for further treatment.

Drug resistance is more common in people who:

• Have spent time with someone with drug-resistant TB disease
• Do not take their prescribed medicine regularly
• Do not take all their medicine
• Develop TB disease again, after having taken TB medicine previously
• Come from areas where drug-resistant TB is common (South East Asia, Latin America, Haiti and the Philippines)

People with MDR-TB disease must be treated with special drugs, which are not as good as the usual anti-TB drugs and may cause more side effects. Some people with MDR-TB disease must consult a TB specialist to observe their treatment to check its effectiveness.

MDR-TB is at least 100 times more expensive to cure than non-resistant TB. At best, only half those infected with new strains can be cured. There is no cure affordable to developing countries for some MDR strains.

People who have spent time with someone with MDR-TB disease can become infected with MDR-TB bacteria. If they have a positive skin test reaction, preventive therapy is important for those at high risk of developing MDR-TB disease, such as children and HIV-infected people.

Up to 50 million people may be infected with drug-resistant TB. MDR-TB comprises about one to two percent of new cases in South Africa.

The worst scenario is that TB will become untreatable due to MDR-TB. MDR-TB usually kills its host, but only after allowing the victim years of life to spread drug-resistant bacteria to others.

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