John Zaracostas
The World Health Organization (WHO) has published new recommendations that seek to speed up detection and enhance cure rates for patients with multidrug resistant tuberculosis (MDR-TB).
The WHO recommends the use of a shorter and cheaper treatment regimen, which is taken for 9–12 months, compared to the conventional and more costly treatment regimens, which are taken for 18–24 months.
“This we consider a critical step forward,” Mario Raviglione, director of WHO’s global tuberculosis (TB) programme, told reporters at a news conference on 12 May 2016.
Philippp du Cros, an infectious disease specialist with Médecins San Frontières, says WHO’s recommendations were “a positive step”, adding that countries should waste no time in putting them into practice.
The new regimen comprises seven drugs: kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid and ethambutol.
Raviglione said that studies of patients with uncomplicated MDR-TB, which is not resistant to second-line TB drugs, resulted in cure rates of 79–87% compared to 50% for the normal regimen.
The shorter drug regimen is estimated to cost less than $1,000 per patient, up to three times cheaper than the normal regimen at $1,500-$3,000.
The shorter regimen is recommended for approximately 70% of the people with MDR-TB, but it can’t be used in patients with second-line drug resistance, extrapulmonary disease and pregnancy.
To help identify patients eligible for the shorter therapy, the WHO has recommended the use of a novel DNA diagnostic test called MTBDRsI, which identifies MDR-TB strains resistant to second-line TB drugs within 24–48 hours, down from the three months at present.
The WHO says an estimated 480,000 people developed MDR-TB in 2014 – about 5% of all TB cases – and 190,000 died from it.
