The major challenge to tuberculosis control is to prevent the emergence of resistance against the major anti-tuberculosis drugs.  As the Global Project on Surveillance of Drug Resistance carried out by the WHO and the Union shows, there are already a number of areas and countries in the world where isoniazid resistance has emerged.  Following isoniazid resistance, additional resistance to rifampicin often ensues.

Patients with resistance to both isoniazid and rifampicin can only exceptionally be cured with the essential drugs.  For many countries this means that such patients have to be left to the natural course of the disease.  They will be transmitting these resistant bacilli uncontrolled to the community before they succumb to the disease.

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