Addressing development of tuberculosis diagnostics and drugs is critical to global antimicrobial resistance response, review finds

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A new tool to diagnose drug-resistant tuberculosis with an improved regimen to then treat it would more than halve the current death toll from the disease within six years, saving 100,000 lives annually, according to a report commissioned by the British government.

AMRThe report brings the findings and recommendations of the Review on Antimicrobial Resistance, which formed two years ago and released an earlier report warning that without a comprehensive effort to address the use and supply of drugs used to fight infections, drug-resistance could take 10 million lives a year by 2050, with a quarter of those lives lost to tuberculosis.

The group’s final report includes 10 recommendations to improve management of current antimicrobial medicines and spur the development of new ones. Its authors call tuberculosis “a cornerstone of the AMR [antimicrobial resistance] challenge.” The report examines challenges posed by drug-resistant strains of tuberculosis within the context of wider challenges of turning a rising trajectory of antimicrobial resistance while acknowledging challenges that currently are specific to tuberculosis. Those include the need for multidrug regimens to treat the disease, and the limited economic resources of countries where the need for tuberculosis treatment is greatest. It warns that “the global response to AMR is fundamentally incomplete if it does not directly address the particular issues of TB.”

Drug-resistant tuberculosis currently kills about 200,000 people a year, the report notes, with about half the people whose tuberculosis is resistant to first-line medicines dying from the disease. Improved diagnostics that would allow appropriate treatment for multidrug resistant tuberculosis would reduce new infections, and in six years would reduce deaths from the disease by an estimated 34,000 each year, according to the authors. A better treatment regimen than the current one requiring a toxic, two-year course of multiple medicines would save about 20,000 lives a year within about three years. The combined impact in six years would lower the current yearly rate of deaths from multidrug resistant tuberculosis by 56 percent, saving 770,000 lives, the authors conclude.

While those projections support the need for new tuberculosis drug and diagnostic tools, practical measures will be needed to support the actual development of them, the authors say. These include sustained funding for tuberculosis research, incentives that reward collaborative work and relevant development, and access — in the case of tuberculosis, rewarding development of regimens over development of single drugs, and rewarding getting drugs to market.

To address the spectrum of antimicrobial resistance globally, the commission recommends:

  1. A global public awareness campaign to reduce unnecessary demand and use of antibiotics that would reach patients, farmers, health providers and policy makers;
  2. National efforts worldwide to reduce infection spread by improving access to clean water and sanitation systems, infection control in health settings, and hand-washing;
  3. Cutting use of antimicrobials in farming, while limiting their presence in water systems (including through sewers and farm runoff);
  4. Improved monitoring and surveillance of drug-resistance;
  5. New, rapid, and point-of-care diagnostic tools that would avert unnecessary or inappropriate use of infection-fighting medicines;
  6. New infection prevention measures, including through the development of new vaccines;
  7. Increased numbers of infectious diseases physicians through improved pay and recognition;
  8. A global fund to finance early stage noncommercial research for new medicines and diagnostic tools;
  9. Improved incentives to invest in new drugs and improve existing ones;
  10. A global coalition for action against antimicrobial resistance formed through the G20 (19 countries and the European Union representing the 20 major economies) or the United Nations.

The Review on Antimicrobial Resistance final report, Tackling Drug-Resistant Infections Globally can be found here.

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