Drug resistance mechanisms and drug susceptibility testing for tuberculosis

Paolo Miotto, Ying Zhang, Daniela Maria Cirillo, Wing Cheong Yam

Research output: Contribution to journalReview articlepeer-review

26 Scopus citations


Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) is the deadliest infectious disease and the associated global threat has worsened with the emergence of drug resistance, in particular multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Although the World Health Organization (WHO) End-TB Strategy advocates for universal access to antimicrobial susceptibility testing, this is not widely available and/or it is still underused. The majority of drug resistance in clinical MTB strains is attributed to chromosomal mutations. Resistance-related mutations could also exert certain fitness cost to the drug-resistant MTB strains and growth fitness could be restored by the presence of compensatory mutations. Understanding these underlying mechanisms could provide an important insight into TB pathogenesis and predict the future trend of MDR-TB global pandemic. This review covers the mechanisms of resistance in MTB and provides a comprehensive overview of current phenotypic and molecular approaches for drug susceptibility testing, with particular attention to the methods endorsed and recommended by the WHO.

Original languageEnglish (US)
Pages (from-to)1098-1113
Number of pages16
Issue number12
StatePublished - Dec 2018


  • antimicrobial susceptibility testing
  • drug resistance
  • molecular mechanisms
  • tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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