After testing about 5,600 existing medications for their effectiveness against drug-resistant strains of tuberculosis (TB), researchers from Weill Cornell Medical College reported this week in the Proceedings of the National Academy of Sciences that oxyphenbutazone, “an anti-inflammatory medication marketed in the 1950s as Tandearil and still used in veterinary medicine,” killed both latent and active TB bacteria in test-tube experiments, the Los Angeles Times’ “Booster Shots” blog reports. The medication is inexpensive, estimated to cost two cents per day in developing countries, according to the researchers, but it needs to go through “a series of clinical trials in which researchers would flesh out, in a human population, the medication’s safety and effectiveness record at various doses, in different patient populations and at different stages of the disease,” the blog writes.
Nature examines efforts to combat antibiotic resistance in India, writing, “Antibiotic resistance is a problem worldwide, but is particularly worrying in India, where hospital standards are inconsistent and antibiotics are readily available over the counter at pharmacies.” The magazine highlights “India’s first joint medical-society meeting on antibiotic resistance, held on 24 August in Chennai,” noting, “The symposium is part of an ongoing campaign by Indian clinicians for a national policy to curb misuse of these vital drugs.” It continues, “Last week, physicians moved a step closer to their goal when India’s drug regulators announced a plan that would put tight restrictions on the sale of antibiotics.”
The Wall Street Journal examines global efforts to stop the spread of drug-resistant tuberculosis (TB) strains, stating, “Global health officials view the emergence of incurable cases of tuberculosis in India as a worrisome evolution in a trend they have been concerned and intensely frustrated about for years — the rise of drug resistant forms of tuberculosis around the world.” The newspaper notes that “last year, a Mumbai doctor reported several cases of TB resistant to the 12 most commonly used medicines,” and adds that “[a]s many as 4.8 percent of all tuberculosis cases are resistant to at least some available drugs, according to a recent study.” The newspaper discusses WHO guidelines to prevent the spread of TB and writes, “Lucica Ditiu, executive secretary of the Geneva-based Stop TB Partnership, an advocacy organization whose members include the World Health Organization, the CDC and others, says only localized action by the countries themselves will bring rates of drug-resistant TB down” (Shah/Anand/McKay, 9/7).
“[O]ver the past month, [tuberculosis (TB)] has captured high-profile attention from the Washington Post, the New York Times, TIME, NPR, [Agence France-Presse] and other major media, generating big headlines about the rising challenge we face in tackling one of humanity’s oldest and most resilient infectious diseases,” Jan Gheuens, interim director of the Bill & Melinda Gates Foundation’s TB Program, writes in the foundation’s “Impatient Optimists” blog. “Why should we be concerned?” he asks. Gheuens says because the worldwide number of multidrug-resistant TB (MDR-TB) cases is growing; “it costs a lot of money to treat MDR-TB”; and “MDR-TB patients must go through two years of intensive treatment, including daily injections for the first six months.” He concludes, “What’s clear now, more than ever, is that making progress on TB will require a comprehensive approach that includes new and better approaches to diagnosis, treatment, and prevention” (9/6).
In a 200th anniversary article for the New England Journal of Medicine, Salmaan Keshavjee of the Department of Global Health and Social Medicine at Harvard Medical School and Paul Farmer of Partners in Health “seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis [TB] by examining the recent history of tuberculosis policy,” they write. The authors outline the history of TB drug development and how the disease became resistant to myriad drugs, and write that by the 1970s, “[t]uberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. They continue, “In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt.”
The Washington Post examines how the “discovery of an almost untreatable form of tuberculosis [TB] in India has set off alarm bells around the world and helped spur a dramatic expansion of government efforts to battle the killer lung disease.” The newspaper writes, “For the past decade, a nationwide tuberculosis program involving millions of health workers and volunteers has made slow but significant progress in battling the disease in India and has been hailed as a public health success story,” but “any sense of complacency was dispelled in December when a doctor in Mumbai, Zarir Udwadia, discovered a strain of the disease that did not respond to any of the 12 frontline drugs.”
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).
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).
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).
More widespread use of antiretroviral drugs (ARVs) to treat HIV infection has led to drug resistance in low- and middle-income countries, but the level “is not steep enough to cause alarm, said a survey released by the World Health Organization on Wednesday,” Agence France-Presse reports. “In low- and middle-income countries, drug resistance stood at 6.8 percent in 2010, the WHO said in its first-ever report on the matter,” the news agency writes, adding, “High-income countries, many of which began widescale treatment for HIV years earlier and used single or dual therapies that can also encourage resistance, face higher rates of resistance, from eight to 14 percent, said the study” (Sheridan, 7/18).