Centers for Disease Control and Prevention

Antimicrobial Resistance Threats Report

Drug-resistantMycobacterium tuberculosis

Threat Level: SERIOUS

In the United States:

Long-term TB treatment regimen costs
CDC changed methodologies and data sources to produce the most comprehensive AR Threats Report to date. Direct comparison of this threat's data to previous reports is not recommended.

What you need to know

Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis, which are spread through the air from one person to the other. TB usually affects the lungs but can also affect other parts of the body or multiple parts of the body at the same time. If not treated properly, TB disease can be fatal.

Drug-resistant TB disease is categorized by the number and type of TB treatments to which the TB bacteria are resistant. First-line drug-resistant TB disease occurs when TB bacteria are resistant to at least one of the four main (first-line) medicines used in TB treatment regimens. Multidrug-resistant TB disease (MDR TB) is caused by TB bacteria that are resistant to the two most potent of the four main TB medicines. Extensively drug-resistant TB disease (XDR TB) is a rare and more serious type of MDR TB that is additionally resistant to a fluoroquinolone and at least one other second-line antibiotic used to treat TB disease.

Some people develop drug-resistant TB disease after they are exposed to drug-resistant TB bacteria. Drug-resistant TB disease can also occur when the medicines used to treat TB are misused or mismanaged. The most important way to prevent drug-resistant TB disease is for all people being treated for TB disease to take all TB medicine exactly as prescribed.

Drug-resistant Mycobacterium tuberculosis data

The percentage of multidrug-resistant TB (MDR TB) and extensively drug-resistant TB (XDR TB) disease cases have remained relatively stable since 2018.

Number of tuberculosis cases with and without drug resistance by year in the U.S.

In 2023, corresponding with an increase in overall cases of TB disease, the number of first-line drug-resistant cases of TB disease in the United States increased to over 1,000 cases. First-line drug-resistant TB disease is resistant to one or more of the four main drugs used to treat TB disease—isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB).

In 2020, reported TB disease cases substantially decreased in the United States, possibly due to factors related to the COVID-19 pandemic, including undiagnosed cases (a result of decreased medical visits) and misdiagnosed cases. Effective TB program strategies in the United States ensured that the percentage of reported MDR TB (resistant to INH and RIF), and XDR TB disease cases (additionally resistant to at least fluoroquinolones and other second-line antibiotics) remained relatively consistent between 2018–2023.

Number of drug-resistant tuberculosis cases by specific resistance type and year in the U.S.

In 2023, of the 6,964 TB disease cases in the United States that have drug susceptibility results for both INH and RIF, 14.8% were resistant to at least one of the four first-line TB drugs and 1.4% were multidrug-resistant.

Treatment costs for TB are substantial. In 2023, estimated costs for short-term treatment regimens for MDR TB ranged from $60,000 to $114,000 per case while long-term treatment regimen costs were $153,000 per case. For XDR TB, the costs of short-term treatment regimens ranged from $128,000 to $316,000 per case while long-term treatment regimen costs were $612,000 per case.

Tenzin's multidrug-resistant TB disease story

A Long Road to Recovery: Tenzin's Story

In this video, Tenzin shares his personal experience of being diagnosed with multidrug-resistant TB disease and managing treatment over the course of two years.

During his last year of college, Tenzin began experiencing chest pains, a sore throat, and coughing. It got to the point that it was painful to even walk or laugh. After several months of experiencing these symptoms and several misdiagnoses, he learned he had active TB disease. Shortly after, Tenzin learned he had multidrug-resistant TB disease (MDR TB).
With the help of his local and state TB programs, Tenzin began the long and challenging treatment process. Tenzin's treatment process for MDR TB disease took over two years. He also needed to isolate until he was no longer infectious.
After recovering from MDR TB disease, Tenzin shares his story to help raise awareness about TB, and address stigma. He also encourages healthcare providers to “Think TB” when they see patients with symptoms like Tenzin's to help patients receive a diagnosis sooner and start treatment right away.

What CDC is doing to end drug-resistant Mycobacterium tuberculosis disease

  • Supporting TB programs

    CDC funds health departments to find and treat cases of TB disease and monitor their close contacts. Thanks to continued investments in public health, the United States has one of the lowest rates of drug-resistant TB disease.

  • Using data for action

    CDC's TB Laboratory serves as the National TB Reference Laboratory and as a source of innovation. CDC tests TB samples to rapidly detect drug resistance, which enables people with drug-resistant TB disease to begin effective treatments earlier and improves outcomes.

  • Detecting outbreaks

    CDC's Antimicrobial Resistance Laboratory Network funds the National TB Molecular Surveillance Center to perform whole genome sequencing on all TB isolates (pure samples of TB bacteria) to identify transmission chains and detect outbreaks.

  • Leading research

    CDC works with academic institutions and health departments to conduct clinical trials and epidemiologic research that contribute to new diagnostics, treatments, and approaches for eliminating TB.

  • Providing training, assistance, and consultation

    CDC supports the TB Centers of Excellence to offer training and support for healthcare professionals treating TB, particularly complex or drug-resistant TB disease.

Drug-resistant Mycobacterium tuberculosis resources

Illustration of Drug-resistant Mycobacterium tuberculosis