The Rise of Drug Resistant Tuberculosis

Proper and complete documentation of harmful drug effects is difficult.

There is also a general reluctance to report unfavorable drug effects.

There is no magic bullet for controlling XDR TB.

The World Health Organization estimates that there were 425,000 new MDR TB cases in 2004, with China, India, and Russia accounting for just over 60 . But it was an outbreak of XDR TB in HIV infected people in KwaZulu Natal, South Africa, that turned the global spotlight on issues of extensively drug resistant organisms.

On the contrary, introducing them into settings where treatment compliance is not assured and where drug susceptibility testing is not available would likely contribute to even more resistant organisms.

Addressing drug resistant TB cannot be divorced from overall TB control efforts.

Moreover, reports of totally drug resistant tuberculosis have recently emerged from India.

Moreover, the direct annual hospital costs attributable to ADR s run into the billions of dollars, and this does not include all the suffering that ADR s cause that does not lead to hospitalization (or death).

Monitoring of ADR s must be more pro active.

Lung cancer cells that are resistant to the chemotherapy gemcitabine are less proliferative, invasive, and motile than their drug sensitive counterparts.

Moreover, the capacity for prompt, accurate laboratory based diagnosis of TB and drug resistance must be strengthened.

And, alarmingly, only one in six patients with drug resistant tuberculosis currently receives proper treatment.

Indeed, surgical resection of affected lungs has become the treatment of choice in many XDR TB hotspots.

It is unfair to blame clinicians for serious ADR s, particularly in the absence of complete safety information.

New, more effective treatment to prevent tuberculosis, especially the multidrug resistant strains, has also helped.

Moreover, in 85 countries, extensively drug resistant (XDR) TB, which is virtually untreatable, has been diagnosed.

In the United States alone, it is estimated that every year up to 100,000 patients die due to serious adverse drug reactions (ADR s).

An unfortunate consequence of treating MDR TB with second line drugs, however, is the inevitable emergence of further drug resistance. If the same factors that produce MDR TB remain in play, then MDR TB becomes XDR TB.

Those who defend such widespread use of prescription drugs insist that a significant part of the population is under treated and, by inference, under medicated.

While clinical trials of the most promising drugs and vaccines need to be pursued, we also need to go back to the drawing board and develop entirely new tactics.

However, over time, other factors behind the growing number of cases, such as immigration and a particular type of drug resistant TB, have emerged.

But who was holding the prescribers to such standards? Doubtless, their understanding of impairment was looser than that of the task force.

Third, better conditions for the approval of new drugs should be matched by better use of drugs, which requires better information for prescribers.

Since 1973, 30 previously unknown infectious diseases have emerged, and other familiar diseases have spread geographically in new, drug resistant forms.

It seems to have made the patient weaker and more addicted to dangerous drugs, as well as more susceptible to new strains of the virus that may, in some cases, eventually prove fatal.

In 2002, more than 90 of communes and precincts had health stations and essential drug funds to meet the people's need for medical examination and treatment.

Urges the Member States to coordinate their efforts and harmonize their systems with respect to the illicit production and trade of narcotic and psychotropic substances within the framework of the relevant international organizations.

If drug companies target diseases that affect only people who are unable to pay high prices for drugs, they cannot expect to cover their research costs, let alone make a profit.

Noting that countries differ significantly in their level of consumption of narcotic drugs and that in most developing countries the use of narcotic drugs for medical purposes has remained at an extremely low level,

Many infectious diseases that ravage developing countries today, notably HIV AIDS and tuberculosis, pose severe risks for the entire world, particularly in the light of emerging drug resistance.

This suggests that resistant cells are not so unfit that drug sensitive cells completely out competed them, but that they struggle to proliferate when both types are present.

Convincing studies of drugs and surgical procedures usually come only from randomized trials, in which patients receive treatment or don t according to a process analogous to a coin flip.

Extensively drug resistant tuberculosis (XDR TB) is a difficult to treat strain of TB which, attacks where health systems are historically weak, especially in areas of high HIV prevalence.

For the first time, voters in the country that is the world s largest consumer of illicit drugs in general, and marijuana in particular, approved propositions legalizing possession, production, and distribution of cannabis and by relatively broad margins.

More importantly, can XDR TB be controlled? Resistance to anti TB drugs arises from selection of naturally occurring mutants with innate resistance to drugs.

Photojournalist James Nachtwey sees his TED Prize wish come true, as we share his powerful photographs of XDR TB, a drug resistant strain of tuberculosis that's touching off a global medical crisis. Learn how to help at http www.xdrtb.org

12. Expresses its concern about the increase in resistant strains of malaria in several regions of the world, and calls upon Member States, with support from the World Health Organization, to strengthen surveillance systems for drug and insecticide resistance

Fifty two of the 53 died in a median of just 16 days from the time of sputum collection. Molecular typing of the isolates indicated that 85 were clonally related, implying epidemic transmission of XDR strains, most likely in HIV clinics and hospital wards.

Progress has also been made since the first reporting cycle, when 14 per cent of States reported having taken measures to counter the use of information technology to promote and distribute illicit drugs, compared with 22 per cent during the third reporting period.

The new GeneXpert test diagnoses not only TB, but also, in the same step, MDR TB, which means that it can rapidly direct adequate treatment and prevent infection of contacts a true breakthrough.

A number of other drugs some new and some repurposed are currently in the last stage of clinical trials, and one new drug has been approved by US regulators for treatment of MDR TB even before such trials have been completed.

Enter XDR TB.

It is believed that ten million intravenous drug users are infected with China (1.6 million), the United States (1.5 million), and Russia (1.3 million) have the highest absolute totals.

Proper and complete documentation of harmful drug effects is difficult. Spontaneous reporting rates to regulatory agencies are low approximately 1 and ongoing monitoring is passive in many countries.