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A Simple Regimen Can Prevent TB. Why Aren’t More People on It?

The world is sorely in need of new ways to prevent TB, not just treat it. Drugs to stave off the infection do exist, but the monthslong regimens are difficult and people often do not finish the prescribed courses.

That may soon change: A new drug course, lasting just one month, is just as effective as longer regimens at preventing TB, scientists reported earlier this year. The results have left experts hoping for new progress against a disease that has been an intractable enemy for centuries.

“I think it’s a moment of really extraordinary promise,” said Mike Frick, co-lead for TB at Treatment Action Group, an advocacy organization.

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  WHO says we can 'write the final chapter in the story of TB.' How close are we?

The head of the World Health Organization is eager to wipe out one of the oldest and deadliest diseases. Last week Tedros Adhanom Ghebreyesus declared: "We have an opportunity that no generation in the history of humanity has had: the opportunity to write the final chapter in the story of TB."

 In The Fight To End Tuberculosis, This Is The Moment For Progress

Drug-resistant TB poses a huge global health threat, with the power to fuel antimicrobial resistance worldwide. But treatment success rates are starting to improve, as advances in drug development have led to shorter and more effective treatment regimens.

 Mind the gap – Managing tuberculosis across the disease spectrum

We currently have a binomial approach to managing tuberculosis. Those with active disease, ideally confirmed microbiologically, are treated with a standard 6-month, multi-drug regimen and those with latent infection and no evidence of disease with shorter, one or two drug regimens. Clinicians frequently encounter patients that fall between these two management pathways with some but not all features of disease and this will occur more often with the increasing emphasis on chest X-ray-based systematic screening. The view of tuberculosis as a spectrum of disease states is being increasingly recognised and is leading to new diagnostic approaches for early disease.

Articles of Interest

A New Dose of Hope in the Battle With Tuberculosis

The approval of pretomanid hinged on results from the Nix-TB trial, which included clinical trials at three sites in South Africa, involving 109 patients with highly resistant tuberculosis. The cure rate was 89%. “Without a doubt, this marks a watershed in our treatment of drug-resistant TB,” said Francesca Conradie, a researcher at the University of Witwatersrand who served as chief investigator in the trials. “If we play our cards right, extensively drug-resistant TB will be a thing of the past within 15 years.”

Cheaper TB drugs for millions after global deal on patent rights agreed

Johnson & Johnson allows generic bedaquiline in 44 countries – but concerns remain about ‘stopgap’ solution.

In Early Results, Shorter Treatment for Tuberculosis Proves Effective

Taking the right antibiotics for just nine months may be as effective against drug-resistant tuberculosis as taking them for two years, as is currently recommended, according to preliminary findings from an international study.

Management of Latent Tuberculosis Infection

Three months of weekly isoniazid and rifapentine is strongly recommended in all adults with LTBI. Compared with 9 months of isoniazid, weekly isoniazid and rifapentine for 3 months had higher completion rates (82% vs 69% [P < .001]), fewer serious adverse events (1.6% vs 2.9% [P < .001]), and less hepatotoxicity (0.4% vs 2.7% [P < .001]) when administered via directly observed therapy, which occurs when a health care worker directly observes an individual taking their prescribed medication.

Mini bio-devices could help TB patients stick to their treatments

Imagine the scenario: you’ve been told you have a disease that will kill you. But, the doctor adds, your life can be saved if you diligently take your medication. Don’t skip a day, don’t skip a dosage. Soon, however, you discover that the medication has a slew of side effects, including a loss of appetite, fatigue, and nausea. So you do stop. This process plays itself out every day among people who have been diagnosed with tuberculosis (TB). Treatment lasts for months. The adherence rate is low.

New and better treatments for drug-resistant tuberculosis on the horizon

The old drugs – half a century old, in fact – are no longer adequate. The standard treatment is a course of antibiotics lasting for six months. With the best will in the world, it is not surprising if some people fail to complete it.

New tuberculosis treatment could help tackle global epidemic

In the studies, adults and children with latent TB infection were given a different antibiotic called rifampin. The results, published in the New England Journal of Medicine, showed that four months of rifampin were as good as nine months of isoniazid. “What we’re showing is that you don’t need isoniazid at all,” said Menzies.

Scientists are developing new, exciting strategies for the fight against TB

There are some glimmers of hope. Globally, TB related deaths dropped by 33% between 2000 and 2017. There’s also a new push from the World Health Organisation (WHO) to reduce new TB cases by 90% by 2035. But for this to happen, new therapies and diagnostic tools are needed. There are some promising therapies in the pipeline, particularly when it comes to host-directed therapies and biomarkers. The first refers to drugs that strengthen the immune system and reduce lung damage. Biomarkers are blood- or tissue-based indicators that tell clinicians about the presence of latent (or dormant) TB, the development of active TB and its progression.

TB drug cocktail could check march of drug-resistant strain

Combination drug treatment kills tuberculosis bacteria in 99% of patients after two weeks in trial.

TB is good at resisting antibiotics. Here are some new ideas to outsmart the bacteria

But because it's challenging to look at a patient's tuberculosis bacteria for all possible mutations, the findings of this work will take time to reach clinics and TB wards. In the meantime, the researchers have made the data from these studies publicly available in an effort to accelerate the fight against the disease. "It's a much bigger project than we can do on our own," Iqbal says.

TB treatments are notoriously hard to stick to: shorter regimens offer a breakthrough

It could be a game changer for two reasons. The first is that the short-course three month or one month regimens can prevent TB in even more people than the current six month regimen. And because it means that people are much more likely to complete their treatments.

The curious characteristics of pyrazinamide: a review

Pyrazinamide (PZA) is an important sterilising tuberculosis drug that helps to shorten the duration of current chemotherapy regimens for tuberculosis.

The deadliest infectious disease is becoming drug-resistant

Tuberculosis (TB) isn’t a disease Americans hear about much about these days, but that’s not true for the rest of the world. TB is currently the deadliest infectious disease, responsible for 1.6 million deaths last year, most of them in the developing world. And that’s not the scariest part. A rapidly growing number of patients are developing drug-resistant tuberculosis, which kills more people than any other drug-resistant pathogen.

The remarkable story of hope: how attitudes to drug-resistant TB changed

The current standard treatment for drug-resistant TB is arduous. It can last for between nine and 24 months, and includes a painful daily injection for up to six months which can cause hearing loss and other serious side effects in up to 60% of patients. Even worse, standard treatment is only successful in about half of all cases.

Tuberculosis (TB): diagnosis, screening, management and data

Information on the diagnosis, screening, epidemiology and public health strategy for tuberculosis and other mycobacterial diseases.

Tuberculosis: A Primer for the Emergency Physician

Treatment is usually started after a definitive diagnosis of TB. Isolation is recommended until at least 2 weeks of therapy have been completed; however, if a patient has multiple drug resistant (MDR) TB, isolation should only end when the AFB smears are negative.

Tuberculosis: Presentation and ED Management

First-line treatment includes 4 drug regimen, plus pyridoxine for 8 weeks. Isoniazid (INH): 300 mg (child 10 mg/kg up to 300 mg) orally daily. Rifampicin (RIF): 600 mg (adult less than 50 kg: 450 mg; child 10 mg/kg up to 600 mg) orally daily PLUS. Ethambutol (E): 15 mg/kg orally daily (up to 1200 mg; in adults and children 6 years or older) PLUS Pyrazinamide (PZA): 25 mg/kg (up to 2 g) orally daily. Pyridoxine: 25 mg orally daily. (20).

Resources

TB Alliance

TB Alliance is a not-for-profit organization dedicated to the discovery, development and delivery of better, faster-acting and affordable tuberculosis drugs that are available to those who need them.

Treatment Action Group

Treatment Action Group (TAG) envisions the end of the HIV, tuberculosis (TB), and hepatitis C (HCV) pandemics with the discovery, development, and worldwide dissemination of safe and effective diagnostics, preventives, and cures through public health structures that end systemic harms and promote human rights, and that are developed by the diverse communities most affected by these conditions.

CDC

There are several treatment regimens recommended in the United States for TB disease. TB treatment can take 4, 6, or 9 months depending on the regimen.