Drug-resistant tuberculosis: Urgent action required!

16.09.2025

A new study with support from the German Center for Infection Research (DZIF) warns of the dawn of an extensively drug-resistant tuberculosis (XDR-TB) epidemic in Europe, threatening to leave physicians without effective medicines in the treatment of tuberculosis. Conducted in the Republic of Moldova, one of the world’s highest-burden countries with drug-resistant tuberculosis, this is the first nationwide evidence in the northern hemisphere of resistance emerging against World Health Organization (WHO) Group A drugs – the cornerstone of today’s tuberculosis treatment.

The analysis of more than 1,000 patients treated between 2021 and 2022 revealed that in 40% of those who failed therapy the tuberculosis bacteria developed new drug resistance. Among these, resistance was strikingly high: 75% of patients failing therapy carried fluoroquinolone-resistant strains, 40% showed bedaquiline resistance, and 38% were resistant to linezolid. Previously, resistance to bedaquiline, the best medicine in the treatment of drug-resistant tuberculosis, had been primarily documented in Southern Africa.

The Moldovan data now demonstrate that nationwide emergence of resistance to WHO Group A drugs is also unfolding in Europe, raising fears of uncontrolled spread. “These findings are a wake-up call,” says lead author Dr. Dumitru Chesov of the State University for Medicine and Pharmacy in Chisinau, R. Moldova and the Research Center Borstel, Leibniz Lung Center in Borstel, Germany. “Resistance is building against the very drugs that form the backbone of treatment regimens in individuals affected by drug-resistant tuberculosis. Without urgent measures, XDR-TB could become a devastating epidemic in the WHO Europe region.”

“The study urges immediate action to strengthen drug-resistance surveillance, ensure adherence, and tailor individualized regimens”, added senior author Prof. Christoph Lange, Medical Director at the Research Center Borstel. “At the same time, development of new medicines and regimens, such as those pursued by the EU-IMI funded UNITE4TB consortium, must be accelerated. It is now critical to implement an antimicrobial stewardship agenda for tuberculosis in Europe in order to combat the emergence of drug resistance and to preserve the remaining effective drugs. XDR-TB is no longer a distant possibility, it is happening right now in Europe,” says Lange.

Publication:

Chesov D, Reimann M, Mukherjee T, Tewatia K, Konstantynovska O, David A, Rusu D, Ciobanu N, Crudu V, Lange C. High rates of acquired resistance to fluoroquinolones, bedaquiline and linezolid in patients failing treatment against drug-resistant tuberculosis in the Republic of Moldova. Clin Microbiol Infect (2025). DOI: 10.1016/j.cmi.2025.09.003

Antibiotikaresistente Tuberkulose fullsizeoutput 5a55