WHO recommendations aim to speed diagnosis, treatment of MDR-TB

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The two years of toxic medicines that make up the common course of treatment for drug-resistant tuberculosis is so grueling and discouraging, as one Médecins Sans Frontières physician put it, that it causes “teenagers to abandon their ambitions, adults to decide between providing for their family or getting healthy and the elderly to wish for death.”

It is one reason treatment for tuberculosis with second-line drugs often fails, with only half of those receiving it, on average worldwide, actually cured, according to the World Health Organization. The others, many forced to quit before treatment is complete, become resistant to more medicines than before, facing a future of continued illness and infectiousness, harsher, longer, and less effective treatments, or death.

Based on studies involving 1,200 patients in 10 countries, WHO now is recommending a treatment regimen that can be completed in 9 to 12 months for patients with multidrug resistant tuberculosis whose disease responds to the most effective second-line medicines. The shorter regimen will cost less than $1000 per patient, less than half the cost of the longer regimen, according to the international health agency. The regimen* consists of seven drugs, and does continue to carry the risk of permanent hearing loss as one of the potential side effects.

While the recommended regimen is expected to be effective for most people with multidrug-resistant tuberculosis, WHO warns that it could lead to further drug-resistance if used on patients already resistant to critical second-line medicines, including the class of antibiotics known as fluoroquinolones, and drugs that are injected.

At the same time WHO is also recommending widespread adoption of a diagnostic test that detects resistance to fluoroquinolones and injected second-line medicines used to treat tuberculosis, and that delivers results in from one to two days. The test, which WHO refers to as “MTBDRsl” identifies genetic mutations in strains of multidrug-resistant tuberculosis that indicate those treatments will not be effective, and according to WHO is the most reliable test to rule out resistance to the drugs. The test, WHO says, can allow health providers to proceed with shorter, second line treatment quickly and with confidence.

Physicians at Médecins Sans Frontières praised both recommendations, while cautioning that development and access to more efficient and effective solutions are still essential, adding that all people with drug-resistant tuberculosis still stand in need of completely new regimens without toxic drugs or painful injections, and noting that the newly recommended test still requires the use of central or regional laboratories.

*Kanamycin, Moxifloxacin, Prothionamide, Clofazimine, Pyrazinamide, high-dose Isoniazid, and Ethambutol.

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