Blog: Combatting Multidrug-Resistant Tuberculosis with Treatment

October 4th, 2016

by Emily Rosenberg, CHHS Research Assistant

Tuberculosis (TB) is no longer the long-gone threat that plagued the urban lower classes of Europe from the Renaissance to the Industrial Revolution. In fact, TB is now more resilient and widespread than ever. It has remained a pandemic disease throughout the world for thousands of years. It is strongest today in Southern Asia, Latin America, West Africa, and Eastern Europe.  In 2014, 9.6 million people contracted TB and 1.5 million people died from the disease. The annual decline of TB in the United States also reached its lowest point of 1.5% that same year, and in 2015 the United States reported an increase of about 150 TB cases.

The terrifying twist to the pandemic is that people now have more to fear than simply contracting TB. Instead, they may need to fear contracting a strain of the bacteria resistant to treatment.  Multidrug-resistant (MDR) strains of TB are resistant to isoniazid and rifampicin, the two most powerful TB drugs. One strain called extensively drug-resistant tuberculosis (XDR-TB) can resist even more drugs than the original MDR-TB strain.  MDR-TB has already appeared in at least one hundred countries. Almost half a million people contracted  multidrug-resistant TB in 2014. Ten percent of these strains were the XDR-TB strain.

Physicians typically administer TB drugs to patients under supervision over a period of six months. However, the current procedure has actually strengthened the virus into the MDR strains plaguing the world today. A combination of incorrect or inappropriate medication usage along with the ease of TB transmission in already crowded treatment facilities have worked together to cause the disease to evolve. The new threat has led scientists to create a new drug called Bedaquiline that specifically combats MDR-TB. In order to prevent MDR strains from adapting to Bedaquiline, doctors must wait to administer the drug until a patient proves resistant to other available treatments. The drug also has severe side effects. Patients taking the drug have a higher risk of mortality and can acquire heart conditions during treatment.

Infected individuals also need access to an affordable and accurate diagnosis method. While the GenXpert disposable cartridge test is a reliable, easy way for doctors to detect whether a TB strain is resistant to rifampicin, the problems with GenXpert are numerous. One, it cannot detect resistance to isoniazid and other TB drugs. The test is also costly to implement and maintain, because it needs a constant source of electricity to operate.

Many developing nations make the right to health a component of their constitutions. They are also parties to healthcare-advocating treaties like the International Covenant on Civil and Political Rights (ICCPR) and the Universal Declaration of Human Rights (UDHR). These nations nevertheless lack the financial resources they need in order to honor and protect the health of their citizens from TB. The nations’ hospitals cannot afford either the electricity necessary to run the reliable GenXpert test or enough Bedaquiline to treat patients who have contracted MDR-TB. Medical professionals in these nations lack the training or space to immediately quarantine infected individuals within treatment facilities. The inability to implement appropriate diagnosis, treatment, and quarantine in various parts of the world have only made MDR-TB strains stronger. Financial assistance from inter- or non-governmental organizations will help develop and deliver new, more affordable treatment options for infected individuals without strengthening current MDR-TB strains. All TB-stricken nations still need to realize the additional importance of isolating and quarantining infected individuals within crowded treatment centers. The benefits of the quarantine far outweigh its temporary restrictions on civil liberties.

If healthcare professionals continue to fail in diagnosing and treating TB, the disease is likely to travel throughout the world and create more “high burden” nations. While medications that target MDR-TB are now available, they are expensive and even dangerous for physicians to use on patients. Existing diagnostic methods are too costly to keep using for much longer, and they cannot detect resistance to all TB medications. Research on new medications, treatment, and healthcare delivery systems are necessary before TB becomes an even larger nightmare.

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