With incentives to find new antibiotics signed into U.S. law last month, “multiple players are vying for the lead in the [multi-drug resistant tuberculosis (MDR-TB)] drug development niche,” Nature Medicine reports. “The fifth reauthorization of the U.S. Prescription Drug User Fee Act (PDUFA), signed into law on 9 July, includes a subsection called the Generating Antibiotic Incentives Now (GAIN) Act that aims to spur development of antibiotics for drug-resistant bacteria, including MDR-TB,” the news service writes, noting, “Drug makers that ask for approval of medicines to treat these pathogens will receive priority review, as well as five additional years of market exclusivity and fast-track status.” Currently, MDR-TB treatment “involves a bevy of regular tuberculosis medicines that, in many cases, must be administered for as long as two years or more … [and] don’t always work,” Nature Medicine states, adding, “The hope is that new medicines will shorten treatment times and improve cure rates.” The article discusses several medicines that are in different phases of research (Willyard, 8/6).
As more bacteria become resistant to antibiotics, “common infections could become deadly, according to” WHO Director-General Margaret Chan, who spoke on Wednesday at a conference titled “Combating Antimicrobial Resistance: Time for Action” in Copenhagen, ABC News reports. “‘Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry,’ said Chan. ‘A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill,'” the news service notes (Moisse, 3/16).
Inadequate Government TB Program, Lax Drug Sale Regulations Contributing To MDR-TB Cases In India, Health Groups Say
“India’s inadequate government-run tuberculosis [TB] treatment programs and a lack of regulation of the sale of drugs that fight the disease are responsible for the [increasing] number of drug-resistant cases that are difficult to treat,” health advocacy organizations said in India last week, the Associated Press/Huffington Post reports. “India adds an estimated 99,000 cases of drug-resistant TB every year, but only a tiny fraction of those infected receive the proper” six- to nine-month antibiotic regimen, according to the AP. In India, government-run TB treatment programs only provide drugs to patients on alternate days, increasing the likelihood of missed doses, and patients increasingly are turning to private physicians who are unaware of how to treat the disease, Medecins Sans Frontieres in India and other health groups said, the news agency reports. “The Indian government had no response Friday to requests for comment on the activists’ allegations,” the AP writes (Naqvi, 3/23).
In this Lancet opinion piece, Madhukar Pai, a professor and tuberculosis (TB) researcher at McGill University and consultant to the Bill & Melinda Gates Foundation, discusses TB control in India. He writes, “Much has been said and written in the media about totally drug-resistant tuberculosis â€¦ However, all of these discussions really miss the key point — that tuberculosis continues to be a huge problem in India, and that the conditions for emergence of drug resistance are undeniably prevalent, in both public and private sectors.”
In this New York Times opinion piece, Frank Smithuis, director of Medical Action Myanmar in Yangon, and Nick White, professor of tropical medicine at the Mahidol Oxford Tropical Medicine Research Unit in Bangkok, recount a brief history of the development of anti-malaria drugs and their contribution to “a significant global reduction in malaria” and note that this progress “is now threatened by the emergence of malaria parasites that are resistant to artemisinin on the Cambodia-Thailand border …, the same place where chloroquine resistance emerged 50 years ago and spread across Asia and Africa to claim millions of lives.” They write, “The spread of artemisinin resistance is a very serious threat to health in the tropics. There are currently no drugs that can satisfactorily replace artemisinins.”
“The Kenyan government’s recent failure to adequately treat a patient with extensively drug-resistant tuberculosis (XDR-TB) has some civil society organizations questioning whether the country’s TB program is equipped to diagnose and treat such patients,” PlusNews reports. “The government admits the TB program in Kenya has not been adequately funded despite the country’s big TB burden,” PlusNews writes, adding, “Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.”
“[O]ften seen in the wealthy West as a disease of bygone eras,” Reuters examines rising rates of tuberculosis (TB) — drug-resistant TB in particular — among the world’s rich and poor. “[R]apidly rising rates of drug-resistant TB in some of the wealthiest cities in the world, as well as across Africa and Asia, are again making history,” Reuters writes. According to the news service, “London has been dubbed the ‘tuberculosis capital of Europe,’ and a startling recent study documenting new cases of so-called ‘totally drug-resistant’ TB in India suggests the modern-day tale of this disease could get a lot worse.”
“About 900,000 cases of active tuberculosis (TB) were discovered and treated [in China] in 2011, including 423,000 infectious cases, the Ministry of Health (MOH) announced Monday at a press conference,” Xinhua reports. “Xiao Donglou, a health inspector from the MOH, said at the press conference that China improved its ability to prevent and control TB last year, focusing on HIV/TB co-infections and cases of TB among the country’s migrant population,” noting “1,701 HIV/TB co-infections were reported last year, as well as 51,682 cases of TB among the migrant population,” the news agency writes.
The Wall Street Journal examines how bureaucracy in India is slowing the treatment of tuberculosis (TB) in the country. The newspaper recounts the story of Rahima Sheikh, “one of 16 patients identified by Mumbai doctors to be resistant to virtually all traditional TB treatments.” The Wall Street Journal writes, “Mumbai officials have publicly pledged free treatment for Mrs. Sheikh and other, similar patients with extreme forms of drug resistance within the city’s jurisdiction,” but “Mrs. Sheikh has now become caught in the bureaucracy of India’s incomplete national network for treating the most virulent TB.”
“One of the most urgent global public health problems is the increasing capability of bacteria to resist antibiotic drugs,” a Washington Post editorial states. “The specter of a world without effective antibiotics has been looming for years, but recent evidence suggests that the superbugs are evolving ever faster,” the editorial continues. “Meanwhile, the pipeline of new antibiotics is running dry, leaving some patients with no effective treatment for life-threatening disease,” it adds.