12.03.2025
Rising antibiotic resistance threatens tuberculosis control in Ukraine
A recent study by researchers from the National University V.N. Karazin in Kharkiv, the State University of Medicine and Pharmacy in Chisinau, Republic of Moldova, and the Borstel Research Centre, Leibniz Lung Centre, shows an alarming increase in fluoroquinolone resistance in patients with drug-resistant tuberculosis in eastern Ukraine.
The incidence of tuberculosis in Ukraine has recently risen sharply and the country has once again been declared a high-risk region for tuberculosis. The ongoing military conflict has significantly impaired the healthcare infrastructure. The uncontrolled use of antibiotics, particularly fluoroquinolones, has further accelerated the development of resistant strains of tuberculosis. The study authors emphasise the urgent need to restore medical care and ensure the proper administration of tuberculosis drugs to prevent a full-scale drug resistance crisis.
The study covers the period from 2019 to 2023 and shows that the resistance rate of Mycobacterium tuberculosis to levofloxacin, a key active substance in tuberculosis therapy, has risen from 10% in 2014 to over 30% in 2022/2023. As fluoroquinolones are essential for the treatment of multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB), this increase poses a significant threat to the containment of the disease.
On a positive note, it should be emphasised that the development of resistance has not yet affected other ‘Group A´ second-line anti-tuberculosis drugs such as bedaquiline and linezolid. Nevertheless, the situation remains critical, as the World Health Organisation (WHO) classifies Mycobacterium tuberculosis with rifampicin resistance as a global health threat of the highest priority. According to the WHO Tuberculosis Report 2024, Eastern Europe, including Ukraine, remains a hotspot for MDR/RR-TB, with up to 20 % of new resistant cases and more than 50 % of resistant relapses.
‘The effective treatment of drug-resistant tuberculosis in Ukraine is becoming increasingly difficult due to growing fluoroquinolone resistance,’ explains Dr. Olha Konstantynovska, lead author of the study from Kharkiv. ‘Increased surveillance and immediate action are urgently needed to prevent further escalation of this health crisis,’ adds Dr. Dumitru Chesov, senior author of the study, who works in both Chisinau and Borstel.
Reference:
Konstantynovska O, Synenko T, Honcharenko A, Volobuieva O, Liadova T, Reimann M, Lange C, Chesov D. Fluoroquinolone Resistance in Drug-Resistant Tuberculosis, Kharkiv, Ukraine, 2019-2023. Emerg Infect Dis. 2025 Mar;31(3):615-617. doi: 10.3201/eid3103.241675. PMID: 40023819
Contact
Dr. Dumitru Chesov
Clinical Infectious Diseases
Research Center Borstel, Leibniz Lung Center