Lead author Reuben M. Granich, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, presented the findings of the study at a JAMA media briefing on tuberculosis at the National Press Club.

The number of tuberculosis (TB) notified cases has decreased by 33 percent in California, from 1994 to 2003, according to background information in the article. TB nevertheless continues to have a substantial public health impact, leading to 233 deaths in 2003. California led the nation in 2003 in the number of cases. Additionally, cases of TB due to strains of Mycobacterium tuberculosis that are at least resistant to the mainstay first-line drugs isoniazid and rifampin (i.e., multidrug-resistant [MDR] strains) continue to appear in California despite high rates of treatment success. The emergence of these life-threatening, airborne strains, which require prolonged treatment for at least 18 months and exhibit higher rates of treatment failure and poorer outcomes, threatens the efficacy of TB control efforts.

Treatment of patients with drug resistance requires considerable expertise and resources; health care cost estimates for individual MDR TB patients in the United States range from $28,217 to $1,278,066. MDR TB has also been associated with serious sizeable hospital and community outbreaks in California and the greater United States.

Dr. Granich and colleagues analyzed drug susceptibility data in the California TB surveillance system to describe the magnitude, trends, geographic distribution, clinical characteristics, risk factors, and outcomes of drug-resistant TB cases to better understand the impact of resistance to multiple drugs on TB control in California and to pl
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Contact: Jessica Frickey
404-639-8895
JAMA and Archives Journals
7-Jun-2005