Drug Resistant TB: A Growing Global Epidemic Even In This Modern Day of Medications and Treatments
Tuberculosis continues to be a major healthcare problem even in this modern day of multiple medications and treatments. With growing difficulty concerning drug resistance, new drugs and repurposing of old standbys are needed more than ever.
Tuberculosis (TB) is one of the top 10 causes of death worldwide. It is estimated that 2 billion people are also chronically infected. The only vaccine developed about 100 years ago offers limited protection and patients are becoming increasingly resistant to what drugs are available (Penn et al, 2018).
The 2014 WHO (World Health Organization) report noted there is a worsening problem with drug-resistant TB. In addition, the true burden of drug-resistant TB across sub-Sahara Africa, Asia, and Eastern Europe are hindered by the fact drug-resistant testing and treatment facilities are mostly unavailable at healthcare facilities.
People with active TB can transmit the disease to others if not treated. Also, people who are treated outside the national TB programs are at increased risk of developing drug-resistant strain. The effort to reduce the transmission of TB must be led by the countries with the heaviest burdens. This study also believes more proactive screening must be done. There is a definite need to increase financial investment into access to quality care. TB is curable and to reach those missing the opportunity of care should be a focus (Zumla et al, 2015).
Ever since the human trials of isoniazid in 1952, Mycobacterium tuberculosis has shown the ability to evade the biochemical bullet aimed at fighting it. Soon TB developed drug resistance in a proportionate number of people.
As time has moved on since then, a new drug was developed to help with the fight, rifampin. Controlled trials found by putting this drug with the two others already at the doctor's disposal, 90% to 100% of patients were safely cured. Science decided it was okay then to cut back on the research being done to find new ways to treat TB. Then when there was an outbreak of Multidrug-Resistant TB 1985-1992, they were caught behind the eight-ball. This outbreak was reported in the country after country proving to be the tip of the iceberg.
It is important to note that prior to the use of rifampin, MDR-TB did not exist, now 40 years after and approximately 490,000 individuals develop it every year. Decrease in the incidence of TB and advances in science and technology show what can be developed with reasonable effort. However, this fight is costly. In the 1990’s there was over 1 billion spent in bringing TB under control in NYC alone.
How much better off would we be now if we hadn’t given in to our own hubris. A large number of MDR-TB patients remain undiagnosed and untreated. In addition, the less affluent countries don’t have the technology readily available to help with this and the expensive drug combinations so the spread goes on unchecked.
New diagnostic tools are now being developed thanks to donations from many groups. It is hoped these new tools can be manufactured to eliminate the usual delay in diagnosis that now can be weeks to months. Support for drug discovery and development must be increased . in addition there is a great need for a broader perspective and research at finding novel uses for already existing medications (Cegielski, 2010).
Despite arguments about the consequences, TB programs have been apprehensive about measuring something so ill-defined. Measurement of suffering can be depressing. Especially among those people who are subject to discriminatory practices. Stigma measurements need to be part of the worldwide larger picture before an effective fight against this disease can be launched. Untreated, undertreated patients who are of the wrong societal cast will only increase the spread of MDR-TB (Mitchel & Daftary, 2017 ).
There is a new drug discovery that this study reported that said there is on track to generate new lead compounds along with their corresponding targets represent treat or need in the fight against TB. Priority for new drug-development to efficiently treat TB must be focused on the discovery of novel therapeutic targets and approaches. This study also found two groups of promising treatment but is still in the beginning stages (Ngmyen et al, 2017).
Antibiotic resistance is a challenge in the treatment of disease today. This is because bacteria and viruses continue to mutate in an effort to dodge the antibiotic bullet. Examples of this are MRSA (methicillin-resistant Staph Aureus) and MDR-TB. This study has found that as soon as they find a drug that works against an organism, within about five years it starts to show resistance to the same drug.
Development of rapid test kits are showing what bacteria is present and what they are resistant to will aid in decreasing unnecessary antibiotic use. The rediscovery of old antibiotics like octapeptins are now being looked at again in the hope they will fight gram negative “superbugs”. It is important all avenues be considered for this war (Kaushal, 2017).
TB is a major public health problem affecting millions of people on a global scale. In 2016, 10.4 million people developed TB resulting in 1.7 deaths. There is a need for countries to demonstrate that TB elimination is possible.
Of the member states of the GHO (Gulf Health Council), only three were among the low-incidence countries. GHC member states were lagging behind in 2010 and progress has been minimal since then. Despite the fact these states have well-financed health system with the treatment at only a nominal fee, there continue to be several challenges.
There is also a need for a stronger and consistent implementation of the programs for all residents. In addition, there is a need to focus treatment on those with impaired immunity as that group is most susceptible (Awsaidy & Kharnis,).
Awaidy, S.T. Kharnis, F. (2018). Tuberculosis in Gulf Health Council Member States: Opportunities and Challenges Toward Tuberculosis Elimination. Omen Medical Journal, 33(3). Doi: 10.5001/omj.2018.35
Cegielski, J.P. (2010). Extensively Drug-Resistant Tuberculosis: There Must be Some Kind of Way Out of Here. Clinical Infectious Diseases, 50(53) Center of Disease Control and Prevention. Doi: 10.1086/651491
Kaushal, A. (2017). Noval Approaches to Target the Antibiotic Resistance in Short Term. Journal of Bacteriology and Mycology, 4(6). doi: 10.15406/jbmoa.2017.04.00114
Mitchell, E.M.H. & Duftary, A. (2017). Tuberculosis Stigma: Clearing the Fog. International Journal of Tuberculosis Lung Disease, 21(11). http://dx.doi.org/10.5588/ijtld.17.0651
Namyen, P.C. Delorme, V. Benarouche,A. Martin, B.P. Paudel, R., Gnowal, G. R. Mandari, A…Canaan, S. (2017). Cyclipostins and Cyclophostin Analogs as Promising Comounds in the Fight Against Tuberculosis. Scientific Reports, 7(11751). Doi: 10.1038/s41598-017-11843-4
Penn et al (2018).- New Approach to Fght Tuberculosis a Leading Cause of Death Worldwide. Gladstone Institute http://www.gladstone.org
Zumla, A., George,A., Sherima, V., Herbert, RHN, Masham, B., Oxley, A. Oliver, M. (2015).The WHO 2014 Global Tuberculosis Report-Further to Go. The Lancet Global Health, 3(1). http://www.thelancet.com/lancetgh,