MDR TB - Multi drug resistant TB

What is MDR TB?

MDR TB is a particular type of drug resistant TB. It means that the TB bacteria that a person is infected with are resistant to two of the most important TB drugs, isoniazid (INH) and rifampicin (RMP). If bacteria are resistant to certain TB drugs this means that the drugs don’t work. Other drugs then need to be taken by the person if they are to be cured of TB.

MDR TB is also known as Multi Drug Resistant TB.

What is RR TB?

RR means rifampicin resistant TB

RR means rifampicin resistant TB

People with RR TB are resistant to rifampicin. They may or may not have resistance to other drugs. MDR/RR TB means patients with MDR  TB as well as patients with TB resistant to rifampicin.

For many years MDR TB has been the most basic form of drug resistant TB, and the type of TB for which many statistics were collected. Then in 2016 RR TB started to become more widely discussed because many people are now being diagnosed with TB using the Genexpert test. The Genexpert test detects resistance to rifampicin as well as resistance to isoniazid

How do you get MDR TB or RR TB?

There are two main ways that you can get them. Firstly you can get them if you don’t take your drugs exactly as you have been instructed to by your health care provider. You may also get MDR TB if you are not taking the correct drugs. This could possibly be because your bacteria are resistant to more drugs than your health care provider realised. Maybe you have undiagnosed XDR TB. This is referred to as acquired TB.

You can also get them if you get TB bacteria from another person who already has MDR or RR TB. This is known as primary TB. It used to be believed that most people have acquired TB. But it is now realised that many more people than were previously realised have primary TB.

How many people have MDR TB?

There were an estimated 484,000 incident cases of MDR/RR-TB in 2018. Half of these cases were in India (27%), China (14%) and the Russian Federation (9%). There is more about TB in India and TB in China.

In 2018 an estimated 3.4% of new cases and 18% of previously treated cases had MDR/RR-TB. The highest proportions are in several countries of the former Soviet Union (above 25% in new cases and above 50% in previously treated cases).

Can MDR TB cause people to die?

In 2018 MDR TB and RR TB caused approximately 214,000 deaths.

Regional estimated incidence of MDR/RR-TB in 2018 for WHO regions

Estimated % of cases with MDR/RR-TB
Region Estimated % of new cases with MDR/RR-TB Estimated % of previously treated cases with MDR/RR-TB
Africa 2.5 12
Americas 2.5 12
Eastern Mediterranean 4 16
Europe 18 54
South-East Asia 2.6 14
Western Pacific 4.6 16
Global Total 3.4 18

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There are some more TB statistics

Treatment of MDR TB

A large number of drugs have to be taken for the treatment of Multi drug resistant TB

A large number of drugs have to be taken for the treatment of MDR TB

In 2019 the World Health Organisation (WHO) recommended that there should be a major change to the treatment for drug resistant TB with shorter regimens being made available for many patients.

Previously treatment for drug resistant TB had often required a large number of drugs to be taken taken for up to two years. Also the drugs often caused severe side effects in patients. So various efforts were being made to develop shorter regimens which were easier to take.

The first shorter and easier to tolerate regimen was known as the Bangladesh regimen. It appears to have a higher cure rate than “standard” MDR TB regimens.

There is more about the treatment of drug resistant TB.

How common is MDR TB?

There are 30 high burden countries for MDR TB.

The tables below show the estimated number of cases for each “high burden” country. But these are only the estimates for the number of cases of MDR TB among those cases of pulmonary TB notified to WHO. There will in addition have been many cases of MDR TB among those cases of TB which were either not detected and/or not notified.

Statistics for MDR TB in "High Burden" Countries 2016
Country Estimated % of new cases with MDR TB or RR TB Estimated % of previously treated cases with MDR TB or RR TB Incidence of MDR TB or RR TB % of MDR among MDR TB or RR TB cases
Angola 2.6 18 4,300 68
Azerbaijan 13 39 2,400 77
Bangladesh 1.6 29 8,800 91
Belarus 38 72 3,400 99
China 7.1 24 73,000 75
DPR Korea 2.2 16 5,700 90
DR Congo 2.2 17 7,600 68
Ethiopia 2.7 14 5,800 62
India 2.8 12 147,000 86
Indonesia 2.8 16 32,000 68
Kazakhstan 26 44 7,000 91
Kenya 1.3 9.4 3,000 59
Kyrgyzstan 27 60 4,800 94
Mozambique 3.7 20 7,600 85
Myanmar 5.1 27 13,000 99
Nigeria 4.3 25 20,000 66
Pakistan 4.2 16 27,000 90
Papua New Guinea 3.4 26 1,900 78
Peru 6.3 24 3,500 89
Philippines 2.6 29 30,000 75
Republic of Moldova 26 56 2,300 97
Russian Federation 27 65 63,000 100
Somalia 8.7 47 3,900 64
South Africa 3.4 7.1 19,000 62
Tajikistan 22 45 2,600 96
Thailand 2.2 24 4,700 86
Ukraine 27 47 21,000 85
Uzbekistan 24 63 10,000 97
Viet Nam 4.1 26 8,200 94
Zimbabwe 4.6 14 1,900 41

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This page was last updated in April 2020.
Author Annabel Kanabus

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