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• W2792027165 abstract "600 000 cases of drug-resistant tuberculosis, causing 240 000 deaths, were estimated by WHO to have occurred worldwide in 2016. 1 WHOGlobal tuberculosis report 2017. World Health Organization, Geneva2017 Google Scholar Cases are expected to increase over the next two decades, driven by the low likelihood that patients will initiate appropriate treatment and, in those who do, the low probability that treatment will succeed. 2 Sharma A Hill A Kurbatova E et al. Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: a mathematical modelling study. Lancet Infect Dis. 2017; 17: 707-715 Summary Full Text Full Text PDF PubMed Scopus (94) Google Scholar Experience in Africa has highlighted the scope and complexity of this problem. In South Africa, where the Xpert MTB/RIF test has fully replaced sputum acid-fast bacilli smear for tuberculosis diagnosis, 59% of rifampicin-resistant patients have additional resistance to second-line drugs (eg, kanamycin, ethionamide, and ofloxacin). 3 Jacobson KR Barnard M Kleinman MB et al. Implications of failure to routinely diagnose resistance to second-line drugs in patients with rifampicin-resistant tuberculosis on Xpert MTB/RIF: a multisite observational study. Clin Infect Dis. 2017; 64: 1502-1508 Crossref PubMed Scopus (13) Google Scholar These drugs are essential for rifampicin-resistant-tuberculosis treatment, yet all three second-line drug susceptibility tests (SL-DST) are performed in only 19% of patients. 3 Jacobson KR Barnard M Kleinman MB et al. Implications of failure to routinely diagnose resistance to second-line drugs in patients with rifampicin-resistant tuberculosis on Xpert MTB/RIF: a multisite observational study. Clin Infect Dis. 2017; 64: 1502-1508 Crossref PubMed Scopus (13) Google Scholar SL-DST is far less available in other high-burden countries. In neighbouring Mozambique for example, WHO estimated 159 000 total tuberculosis cases and 7600 rifampicin-resistant cases of disease in 2016. 1 WHOGlobal tuberculosis report 2017. World Health Organization, Geneva2017 Google Scholar However, of the 73 480 notified cases, only half were tested for rifampicin-resistance, and only 868 had SL-DST performed. The resulting 25 cases of confirmed extensively drug-resistant tuberculosis are likely to be just a small fraction of the country's true burden. These grim statistics reflect the intrinsic shortcomings of current diagnostics compounded by the implementation challenges they pose. Drug-resistant tuberculosis patients who receive less than fully effective treatment experience increased mortality and contribute to ongoing transmission of increasingly resistant isolates, thereby fuelling the epidemic. 4 Cegielski JP Dalton T Yagui M et al. Extensive drug resistance acquired during treatment of multidrug-resistant tuberculosis. Clin Infect Dis. 2014; 59: 1049-1063 Crossref PubMed Scopus (114) Google Scholar Pan-tuberculosis regimens: an argument againstIn 1986, after publication of a seminal paper about the use of short-course regimens for tuberculosis treatment, there was great optimism that a universal regimen for tuberculosis had been discovered.1 Pierre Chaulet described the short-course regimens as “highly effective and reliable with the minimum of constraints either for patients or for health personnel.”2 Unfortunately, the emergence of rifampicin-resistant Mycobacterium tuberculosis strains soon rendered these short-course regimens ineffective for many individuals. Full-Text PDF Pan-tuberculosis regimens: re-framing the argumentTwo Comments published earlier this year in The Lancet Respiratory Medicine discussed pan-tuberculosis regimens,1,2 which conceptually are combinations of newly approved anti-tuberculosis drugs or those in development that have novel mechanisms of action not previously available for use in treating patients. Because pre-existing resistance to such drugs is probably minimal, the need for drug-susceptibility testing and tailored treatment regimens is removed; thus, a single and ideally shorter regimen than the various 6–24 month regimens currently used to treat patients could be used to treat all patients with active pulmonary tuberculosis. Full-Text PDF" @default.
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• W2792027165 date "2018-04-01" @default.
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• W2792027165 title "Pan-tuberculosis regimens: an argument for" @default.
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