World-wide warning of highly drug-resistant tuberculosis
Extensively drug-resistant tuberculosis
New forms of highly drug-resistant tuberculosis are emerging and action must be
taken soon before they become widespread globally, says an editorial in this
week's BMJ.
The authors say that urgent action is needed to implement effective
tuberculosis control strategies, especially in countries where tuberculosis
control practices have been inadequate.
Research is also needed to assess the extent of the spread of these highly
drug resistant strains of tuberculosis worldwide and improved means of diagnosis
of tuberculosis and early detection of drug resistance are urgently required,
they add.
Among 536 cases of tuberculosis confirmed at a rural hospital in South Africa
earlier this year, 41% were multi-drug resistant and of those, 24% met the exact
definition of being extensively drug resistant tuberculosis (also referred to as
XDR tuberculosis). Such tuberculosis is almost untreatable.
All patients in this outbreak who were tested were HIV positive and 52 of the
53 died after an average of 25 days.
Strains of extensively drug resistant tuberculosis have also been noted in
Europe, Asia and North and South America. It appears that there are several
strains of this tuberculosis.
Author Dr Stephen Lawn, senior lecturer in infectious and tropical diseases
at the University of Cape Town, South Africa, says that drug resistance to
tuberculosis results largely from poorly managed care and control of the
disease.
Poor prescribing practices, low drug quality (or erratic supply) and poor
adherence to drugs can all contribute to this resistance to drugs. Where HIV
rates are high, this allows particularly rapid spread of the disease within
hospital settings and the community.
Dr Lawn says several responses to this problem are required including urgent
assessment of the scale of the problem and an increase in laboratory capacity.
"Detection rates for cases of tuberculosis need to be improved,
highlighting the need for a new diagnostic test," he writes.
"Technologies that can determine the presence of drug-resistance at the
point of care are needed as are new drug treatments." - BMJ
More information:
 Contact: Emma Dickinson
EDickinson@bmj.com
44-020-738-36529
BMJ-British Medical Journal BMJ-British Medical Journal
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