Scientific American examines how strains of cephalosporin-resistant gonnorhea have “been emerging in Japan, and moving east and west from there, for at least a decade.” The magazine writes, “Rapid international travel allowed the resistance mutation to hopscotch the globe,” noting antibiotic-resistant strains that have been identified in Sweden, England, Norway, the Philippines, Spain, and France. “‘We can’t go back to older antibiotics,’ says Peter Leone, who is board chair of the National Coalition of STD Directors and medical director of North Carolina’s STD prevention program. ‘Once resistance emerges in gonorrhea, it is there for good. Cephalosporins are all we have left,'” he added, according to Scientific American. The magazine writes that efforts “to educate physicians and patients, to track resistant strains and to develop new treatments … must be carefully targeted and well coordinated with one another,” and concludes, “If not, truly untreatable gonorrhea, and its expensive, destructive consequences, could be the worldwide result” (McKenna, 5/4).
The Institute of Medicine (IOM) on Friday released a summary of a joint workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research, titled, “Facing the Reality of Drug-Resistant Tuberculosis: Challenges and Potential Solutions in India.” According to the report’s webpage, “The aim of the workshop was to highlight key challenges to controlling the spread of drug-resistant strains of [tuberculosis (TB)] in India and to discuss strategies for advancing and integrating local and international efforts to prevent and treat drug-resistant TB” (4/27).
A strain of malaria that is resistant to artemether, the main ingredient in Coartem, a widely used drug to treat the disease, may be spreading in Africa, according to a study published Thursday in Malaria Journal, Bloomberg Businessweek reports. “Studies in Cambodia and Thailand have shown that drugs based on artemisinin, the class of remedies to which artemether belongs, are becoming less effective there,” the news service writes, adding that study author Sanjeev Krishna of the University of London said, “Drug resistance could eventually become a devastating problem in Africa, and not just in southeast Asia where most of the world is watching for resistance.” According to the authors, “[t]he effectiveness of other artemisinin-based drugs, such as artesunate, wasn’t significantly affected by the mutations,” the news service states (Bennett, 4/26).
“The World Health Organization heralded major gains Tuesday in the fight against malaria, one of the developing world’s biggest killers, but warned universal access to treatment remains elusive,” Agence France-Presse reports, noting, “The assessment came on the eve of World Malaria Day,” observed Wednesday and “designed to shine the light on the mosquito-borne parasite that killed 655,000 people in 2010, including 560,000 children under five” (4/24). “A massive acceleration in the global distribution of mosquito nets, the expansion of programs to spray the insides of buildings with insecticides, and an increase in access to prompt antimalarial treatment has brought down malaria mortality rates by more than a quarter worldwide, and by one-third in Africa since 2000,” but “simply maintaining current rates of progress will not be enough to meet global targets for malaria control,” the agency writes in a news release (4/24).
“In recent weeks, the emergence on the Thai-Myanmar border of malaria strains resistant to artemisinin, a plant-derived drug, have led to pessimistic headlines and reminders of the setback caused by resistance to the drug chloroquine, which began in the 1950s,” columnist and author Matt Ridley writes in the Wall Street Journal’s “Mind & Matter,” noting, “April 25 is World Malaria Day, designed to draw attention to the planet’s biggest infectious killer.” He continues, “For this reason, prevention generally works better than cure in eradicating infectious diseases: Vaccination beat smallpox, clean water beats cholera, less crowded living beats tuberculosis and protection from mosquitoes beats malaria.”
Yaws, a skin and bone disease caused by a treponematoses bacterium that can cause long-term deformities, “has recently been put on WHO’s list of 17 so-called neglected tropical diseases (NTDs)” and, along with Guinea worm, is “slated for eradication,” the Lancet reports. A “massive push to free the world from yaws failed in the 1950s and 1960s,” and the WHO in 1995 estimated “there were 2.5 million cases of endemic treponematoses (mostly yaws),” according to the Lancet. A study published in the Lancet in January showed a single dose of the antibiotic azithromycin was effective at curing the disease among children, a finding that “jump-started the NTD community into action,” the article states.
A strain of malaria that is resistant to artemisinin combination therapy (ACT) is spreading along the Thai-Myanmar border and has the potential to spread to Africa if efforts to effectively treat and prevent the disease are not undertaken, according to a study published in the Lancet on Friday, Reuters reports (Lyn, 4/5). Since 2008, patients treated with ACT have been slower to clear the parasite than previously, “[a]nd this precursor to resistance seems to be spreading, despite efforts to carefully use artemisinin (by giving it in combination with other drugs) to avoid the emergence of resistance,” Scientific American writes.
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.”
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.”
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).