Drug resistant TB occurs whenever a TB patient’s sample is observed to have resistance to any of the first line TB medicines. Various types of drug resistance occurs such as mono and poly resistant TB. Most significant to the Programme is the occurrence of Rifampicin Resistance (resistance to Rifampicin alone or in combination with other medicines) and Multidrug Resistance (resistance to Isoniazid and Rifampicin together and in combination with other medicines).

Treatment of drug resistant TB is very difficult and expensive. Treatment lasts for 2 years including minimum 8 months of injections; side effects of medicines are very severe including hearing loss; medicines cost up to 100 times more than first line medicines ($25 compared with $2,500) and treatment outcomes are much poorer with the possibility of evolving Extensively Drug Resistant TB (XDR-TB) where resistance occurs to the second line medicines.    

Following the evidence found from global in finding most effective and safest drugs with reduced treatment duration for the treatment of drug resistant TB, an ongoing regimen change occurred since 2016.  Previously MDR TB treatment was provided for 24 months, XDR TB for 36 months. Most of the MDR TB dugs used previously include injectables which resulted with a lot of serious adverse reactions including permanent loss of hearing. World Health Organization released rapid communication in December 2019 followed by new guideline for the treatment of Dug Resistant TB on June 15, 2020.  

Because of documented toxicity and other side effects WHO recommended to phaseout injectable drugs in the treatment of drug resistant TB. New drugs including bedquiline and Delamanid had been recommended in the place of those injectables. Following the recommendation, Following the WHO recommendation, all drug resistant TB patients in Ghana has been transited to all oral regimen starting from January 2020.  WHO also recommended new drug pretomanid to be provided together with bedaquiline and linezolid for 6-9 months for quinolone resistant or extensively drug resistant TB under operational research.