“One in 10 cases of tuberculosis in China cannot be treated by the most commonly-used drugs, driven by a lack of testing and misuse of medicine, according to a national survey that showed for the first time the size of the drug-resistant epidemic,” the Associated Press reports (Wong, 6/7). “‘In 2007, one third of the patients with new cases of tuberculosis and one half of the patients with previously treated tuberculosis had drug-resistant disease,’ said the study in the New England Journal of Medicine,” Agence France-Presse reports, adding, “Even more, the prevalence of multi-drug resistant [tuberculosis (MDR-TB)] in new cases (5.7 percent) was nearly twice the global average, said the study” (6/6).
“Researchers who tested a novel type of antibiotic against multi-drug-resistant tuberculosis [MDR-TB] are reporting that nearly half of patients who got the new drug cleared the bacteria from their lung fluid in two months,” according to a study published Thursday in the New England Journal of Medicine, Reuters reports. Japanese pharmaceutical company Otsuka developed the experimental drug, delamanid, and “also designed and financed the clinical trial, which took place in 17 medical centers across nine countries,” the news service writes (Emery, 6/6).
Noting that the “[r]oll-out of antiretroviral treatment for HIV in sub-Saharan Africa has been accompanied by rising rates of drug resistance,” Raph Hamers, a global health research fellow at the Academic Medical Centre of the University of Amsterdam, and colleagues “call for improved patient management and the integration of population-based drug resistance surveillance into national treatment programs” in this BMJ analysis. “In sub-Saharan Africa, the region with the highest HIV/AIDS burden, high-level political commitment and substantial international funding have led to an unparalleled scale-up of access to treatment over the past eight years,” they write, adding, “However, little attention has been paid to the potential emergence and spread of drug-resistant HIV and its public health implications.”
The Wall Street Journal reports on a rise of multi-drug resistant tuberculosis (TB) in India, writing, “India’s slow response to years of medical warnings now threatens to turn the country into an incubator for a mutant strain of tuberculosis that is proving resistant to all known treatments, raising alarms of a new global health hazard.” The newspaper continues, “Spread of the strain could return tuberculosis to the fatal plague that killed two-thirds of people afflicted, before modern treatments were developed in the 1940s, said Dr. Mario Raviglione, director of the Stop TB Department of the World Health Organization.” The newspaper notes, “The WHO is now assisting India to combat the strain” (Anand, 6/19).
In a study published on Wednesday in the Lancet, researchers from the Centers for Disease Control and Prevention found that “[a]mong 1,278 patients who were resistant to two or more first-line tuberculosis drugs in Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea and Thailand, 43.7 percent showed resistance to at least one second-line drug,” which “suggest[s] the deadly disease may become ‘virtually untreatable,'” according to the study, Bloomberg Businessweek reports (Kitamura/Narayan, 8/29). “In about a fifth of cases, they found resistance to at least one second-line injectable [versus oral] drug,” according to Reuters, which states “[t]his ranged from two percent in the Philippines to 47 percent in Latvia.” Overall, 6.7 percent of patients had extensively drug-resistant TB (XDR-TB), meaning patients are resistant to the first-line drugs isoniazid and rifampicin as well as drugs in the fluoroquinolone antibiotic class and a second-line injectable antibiotic, Reuters adds, noting “[r]ates in South Korea, at 15.2 percent, and Russia at 11.3 percent, were more than twice the WHO’s global estimate of 5.4 percent at that time” (Kelland, 8/30).
The U.S. Government Accountability Office (GAO) recently released two reports on issues related to global health. In “Ensuring Drug Quality in Global Health Programs,” the agency writes, “Concerns have been raised about the potential for substandard drugs to enter the supply chains of global health programs,” and notes that it concluded, “U.S.-funded global health programs have put regulatory and policy requirements in place to help prevent procurement of substandard drugs” (8/1). In another report looking at the WHO, titled “Reform Agenda Developed, but U.S. Actions to Monitor Progress Could be Enhanced,” GAO found, “The United States has provided input into WHO’s reform agenda, particularly in the areas of transparency and accountability, but the Department of State’s (State) tool for assessing progress in the area of management reform could be enhanced” (7/23).
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.”