Paper II
2020 February (Supplementary) (2010 Scheme)

Question

Multidrug therapy for tuberculosis

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Answer

Multidrug therapy is used in tuberculosis because: (1) M. tuberculosis has a high mutation rate, and using multiple drugs with different mechanisms of action prevents the emergence of drug-resistant mutants (since simultaneous spontaneous resistance to multiple drugs is statistically very unlikely), (2) different drugs act on different bacterial populations — actively dividing extracellular organisms, slow-growing intracellular organisms, and dormant/persister organisms within caseous lesions — requiring a combination to eradicate all subpopulations, and (3) it allows shorter, more effective treatment courses while reducing the risk of relapse and treatment failure.

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