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Connections between tuberculosis (TB) and antimicrobial resistance (AMR)

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Antimicrobial Resistance (AMR), Tuberculosis (TB)
March 21, 2026

Image geneated by Gemini

Not All TB Is the Same: Understanding Drug-Resistant Tuberculosis

Each year on World TB Day, the global health community pauses to reflect on the ongoing fight against tuberculosis (TB). Despite decades of progress, TB remains one of the world’s leading infectious causes of death. Yet the disease carries a hopeful truth: TB is both preventable and curable when diagnosed early and treated with the right medicines.

However, the fight against TB is becoming more complicated. One of the greatest challenges facing health systems today is the growing problem of drug-resistant tuberculosis. In these cases, the bacteria that cause TB no longer respond to some of the medicines normally used to treat the disease.

Drug-resistant TB is one of the clearest examples of Antimicrobial Resistance (AMR), a global health threat in which bacteria evolve and become resistant to medicines that once worked effectively. When this happens, infections become harder to treat, treatments become longer and more expensive, and the risk of transmission increases.

Understanding the different forms of TB, especially drug-resistant TB, is therefore important not only for healthcare professionals but also for patients, families, and communities. It also highlights a critical message: taking TB medicines exactly as prescribed can protect both individual health and the effectiveness of these medicines for others.

What is Tuberculosis?

Tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. The disease most commonly affects the lungs, a condition known as pulmonary TB, but it can also affect other parts of the body such as the lymph nodes, bones, or even the brain.

TB spreads through the air. When a person with active TB of the lungs coughs, sneezes, laughs, or speaks, tiny droplets containing the bacteria can be released into the air. People nearby may inhale these bacteria and become infected.

The symptoms of TB can develop gradually and may include:

  • A cough lasting longer than two weeks
  • Chest pain
  • Weight loss
  • Fever
  • Night sweats
  • Fatigue or weakness

Although TB is a serious disease, it is also treatable and curable. Standard TB treatment uses a combination of antibiotics taken over several months to kill the bacteria and prevent the infection from spreading.

Drug-Sensitive TB: When Treatment Works Well

Most people diagnosed with TB have what is called drug-sensitive TB. In these cases, the TB bacteria respond well to the standard medicines used to treat the disease.  Treatment usually involves taking a combination of antibiotics for about six months. When the medicines are taken consistently and the full course of treatment is completed, the chances of cure are very high.

Completing treatment is essential. Even when patients begin to feel better after a few weeks, some TB bacteria may still remain in the body. If treatment is stopped too early or taken irregularly, these remaining bacteria can survive and begin to adapt.  It is during this process that drug resistance can develop.

When TB Medicines Stop Working

Drug-resistant TB occurs when TB bacteria survive exposure to TB medicines and develop the ability to resist them. Once this resistance develops, the medicines that previously worked may no longer be effective.  Drug-resistant TB can develop in two main ways.

First, it can arise during treatment. If medicines are missed frequently, taken incorrectly, or stopped too early, some bacteria may survive and gradually become resistant.

Second, people can become infected directly with a strain of TB that is already resistant to certain medicines. In this case, drug-resistant TB is transmitted from one person to another.

Either way, the result is the same: the infection becomes more difficult to treat and requires different medicines and longer treatment regimens.

Rifampicin-Resistant TB

One of the earliest forms of drug resistance occurs when the TB bacteria become resistant to rifampicin, one of the most important first-line TB medicines.  This form of the disease is known as rifampicin-resistant TB, often abbreviated as RR-TB.

Because rifampicin is a key drug in standard TB treatment, resistance to it can significantly complicate treatment. Patients diagnosed with RR-TB often require specialised treatment regimens similar to those used for multidrug-resistant TB.

Multidrug-Resistant TB

A more serious form of drug resistance is Multidrug-Resistant Tuberculosis (MDR-TB).

MDR-TB occurs when the TB bacteria are resistant to at least two of the most powerful first-line TB medicines: isoniazid and rifampicin. These two drugs form the backbone of standard TB treatment, and when both become ineffective, treating the infection becomes much more challenging.

Patients with MDR-TB usually require:

  • Longer treatment regimens
  • Second-line antibiotics
  • Regular monitoring for side effects

Treatment for MDR-TB can last nine to eighteen months or longer, depending on the medicines used and the patient’s response to treatment.

When Resistance Becomes Even Stronger

In some situations, MDR-TB can become even more resistant.

When the TB bacteria are resistant to MDR-TB medicines and also to an important group of antibiotics known as fluoroquinolones, the condition is referred to as pre-extensively drug-resistant TB, or pre-XDR TB.

Fluoroquinolones are among the most effective medicines used to treat resistant TB. When these drugs also become ineffective, treatment options become significantly more limited.  This stage illustrates how drug resistance can gradually accumulate when TB bacteria are repeatedly exposed to medicines but not completely eliminated.

Extensively Drug-Resistant TB

One of the most severe forms of the disease is Extensively Drug-Resistant Tuberculosis (XDR-TB).

In XDR-TB, the bacteria are resistant to multiple important medicines, including:

  • Isoniazid
  • Rifampicin
  • Fluoroquinolones
  • At least one additional key second-line TB drug

Because so many medicines are ineffective against these strains, treatment becomes more complicated and may require specialised care and newer medicines.  Although advances in TB treatment are improving outcomes, XDR-TB remains a major public health concern worldwide.

TB and the Global Challenge of Antimicrobial Resistance

Drug-resistant TB is a powerful example of Antimicrobial Resistance in action.

Antimicrobial resistance occurs when microorganisms such as bacteria evolve in ways that allow them to survive exposure to medicines designed to kill them. As resistance spreads, infections become harder to treat and the medicines we rely on become less effective.

The consequences can be serious:

  • Treatments become longer and more complicated
  • Healthcare costs increase
  • Patients may experience more side effects
  • Resistant infections can spread within communities

This is why drug-resistant TB is both a TB challenge and an AMR challenge.

Why Taking TB Medicines Matters

One of the most powerful ways to prevent drug-resistant TB is simple but critical: taking TB medicines exactly as prescribed and completing the full course of treatment.

When TB treatment is taken correctly:

  • The bacteria are effectively killed
  • The infection is cured
  • The risk of resistance developing is greatly reduced

However, if treatment is interrupted or stopped early, surviving bacteria may adapt and become resistant. These resistant bacteria can then multiply and spread.  For this reason, healthcare providers place strong emphasis on treatment adherence, follow-up visits, and patient support throughout the treatment process.

What Patients and Communities Can Do

Preventing drug-resistant TB is not only the responsibility of healthcare systems. Patients, families, and communities all play an important role.

If you or someone you know develops symptoms of TB:

  • Seek testing as early as possible
  • Follow medical advice carefully
  • Take TB medicines exactly as prescribed
  • Complete the full course of treatment
  • Attend scheduled clinic visits

Supporting people undergoing TB treatment is equally important. Encouragement, understanding, and reducing stigma can help patients stay on treatment and complete their medicines successfully.

A Shared Responsibility

TB is a disease that humanity already knows how to cure. The challenge is ensuring that the medicines we rely on continue to work.

By understanding the different types of TB and the risks of drug resistance, individuals and communities can help protect the effectiveness of these life-saving medicines.

On World TB Day, the message remains clear and hopeful:

TB can be cured. Completing treatment protects not only your health, but also the future of TB treatment for everyone.

Prof Renier Coetzee

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Renier Coetzee is an associate professor at the University of the Western Cape’s (UWC) School of Public Health (SOPH). His work focuses on antimicrobial stewardship, with a particular emphasis on improving antibiotic use in low- and middle-income countries. In addition to his research, Renier is dedicated to community engagement and empowerment. He works closely with local communities to develop and implement sustainable health interventions and promote health equity and social justice. Through his work, Renier seeks to bridge the gap between academia and community, ensuring that research is translated into meaningful action. His commitment to antimicrobial stewardship and community engagement has made a significant impact in the field, and his work continues to inspire and inform public health initiatives.

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Abi Mc Alester

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Nduta Kamere

Nduta is a global health pharmacist and AMR consultant recognised for her leadership in antimicrobial stewardship, One Health, and healthcare equity. She has shaped AMR strategies and advanced healthcare accessibility across Africa, with a significant portfolio that includes contributions to the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programmes. As Technical Lead, she oversaw the co-development of the Quadripartite Antimicrobial Resistance Toolkit for Youth Engagement, now used globally to drive advocacy and behaviour change.

Her expertise spans supply chains, pricing, and substandard and falsified medicines, and her research is published in the WHO Bulletin and peer-reviewed journals, informing regional and global AMR policy and practice.

Dr Marie-Anne Bouldouyre

Dr Marie-Anne Bouldouyre is an infectious diseases physician and hospital practitioner in Paris. Twelve years of clinical work in a suburban hospital shaped her understanding of access to care, patient relationships, and the daily reality of antimicrobial resistance.

Since 2022, she has led the Regional Antibiotic Stewardship Centre in Île-de-France and coordinates the national network, working with a multidisciplinary team to promote responsible antibiotic use and strengthen collaboration among healthcare professionals. She also continues to manage complex infections at Saint-Louis Hospital.

Convinced that antimicrobial resistance cannot be tackled by healthcare workers alone, she advocates for the active involvement of patients : understanding, questioning, and taking part in decisions about antibiotics. Their stories are essential to making this issue visible and concrete.

She is proud to collaborate with initiatives such as The AMR Narrative and hopes to foster similar projects in France to give patients a voice in this shared fight.

Dr Erva Cinar

Dr Erva Cinar is a London based paediatric resident doctor and clinical researcher with interest in infectious diseases.

She is currently completing a Master’s in Public Health at the London School of Hygiene & Tropical Medicine. Through the World Medical Association’s Junior Doctor’s Network (WMA-JDN) AMR Working Group, she engages in policy and advocacy on antimicrobial resistance and stewardship at global level.

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Hamu Madzedze

Hamu Madzedze is a seasoned Zimbabwean journalist with over 15 years’ experience.

She previously worked for the Zimbabwe Broadcasting Corporation as a reporter and sub-editor, before establishing an independent website, 365HealthDiaries, which focuses on health and gender issues.

She holds a BA in Media Studies and a BA (Special Honours) in Communication and Media from the Zimbabwe Open University, as well as a diploma from the Christian College of Southern Africa.

Her work has been recognised with several awards, including the Global AMR Special Mention Award (2024), the Sexual Health Rights and Equity Fellowship Special Mention Award (2025), and the Merck Foundation Award (2024) for outstanding coverage of health issues, gender, infertility, and genital mutilation, where she achieved third position in the Online Category.

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Jomana F. Musmar

Dr. Jomana Musmar is a distinguished global policy expert and proactive leader with over fifteen years of government experience in strategic planning, operational design, and policy execution. Renowned for simplifying complex topics with expertise and diplomacy, she has spearheaded innovative solutions to global health challenges, shaped impactful policies, and advanced national and international missions.

As the Executive Director of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, she established and led the council’s operations, liaising with over 600 experts, worldwide, across government, industry, and academia. Her efforts culminated in the development of critical recommendations addressing antimicrobial resistance and interrelated One Health issues, influencing both domestic and global health strategies.

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Chris Shaffer

Chris Shaffer was a music, special education teacher, and high school principal for 45 years. At the end of his educational career, he was thrust into the world of AMR infections when a number of abdominal surgeries left him with an E-coli infection which failed to respond to antibiotics. After doctors in the USA left him with little hope for a cure, diminishing health, and a bleak prognosis, he set out on his own.

Chris found success in phage therapy at the Eliava Phage Therapy Center in Tbilisi, Georgia. With phage therapy giving Chris his life back, he has dedicated his retirement years to advocating for and helping raise awareness of phage therapy used for AMR infections. He tells the story of his phage journey in a book titled, Finding Phage: How I Partnered with a Friendly Virus to Cure My Deadly Bacterial Superinfection. His website, phagetherpyusa.com helps others learn to understand the healing power of phage therapy.

Demi Christofi

Demi is an Associate Scientific Director at a medical communications agency, with a background in microbiology and a longstanding focus on antimicrobial resistance. She holds an MSc in Microbiology, where she first became interested in the global challenge of resistance and the need to bring scientific understanding to wider audiences.

Demi’s career has centred on a simple but powerful belief: that how we communicate science matters. Her work focuses on making complex data clear, engaging, and accessible – whether for healthcare professionals, policy makers, or the patients most affected by infection and resistance. She has contributed to a wide range of AMR-focused projects, including educational programmes, congress communications and stewardship initiatives.

A central thread in Demi’s work is the importance of the patient voice. She is passionate about making sure real-world experiences of treatment failure, recurrent infections, and the anxiety surrounding resistance are not lost in the data. She believes that listening to patients and involving them meaningfully is essential for shaping more effective, human-centred responses to AMR.

Demi is also a strong advocate of the One Health approach, recognising AMR as a complex, interconnected issue that spans human health, animal health, and the environment. She is particularly drawn to efforts that move beyond siloed thinking and focus on practical, joined-up solutions.

In 2025, Demi joined The AMR Narrative as an Independent Advisor, where she supports the charity’s mission to centre communication, community, and inclusion in the global AMR response.

Outside of work, she is a Girlguiding unit leader and a qualified yoga teacher. These roles reflect her commitment to care, learning, and creating supportive spaces for others.

Andrea Hartley

Andrea has worked in health communications and campaigning for 3 decades. She is committed to fighting AMR through timely and appropriate communications globally,.

Andrea set up Skating Panda, the creative social and environmental impact consultancy, over a decade ago and drives its impact and growth. Focused on original and lasting public interest communications as well as issue strategy and advocacy, the Panda team has a track record of prompting tipping points in the status quo that drive better social and planetary outcomes.

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Andrea is Vice Chair of mothers2mothers, the world’s largest employer of women living with HIV, and a Board Director of Maymessy, a food poverty social enterprise.

A lifelong advocate for gender equality, she played a key role in establishing the UK’s Women’s Equality Party.

Esmita Charani

Professor Esmita Charani is a pharmacist and researcher investigating how we use antibiotics in different cultural and social contexts. She works with teams in the UK, India, and South Africa to develop research programmes investigating all aspects of antimicrobial resistance in human populations with a focus in hospital settings.

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