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The effect of antibiotic resistance on the treatment of TB

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Kane Longden

on 27 April 2010

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Transcript of The effect of antibiotic resistance on the treatment of TB

The effect of antibiotic resistance on the treatment of TB However, treatment had to be continued with good quality drugs for as long six months to ensure cure. The difficulties in ensuring this occurs, especially in resource poor countries, has resulted in an increasing incidence of tubercle bacteria resistant to the most effective drugs; so called multi-drug resistant tuberculosis. n the second half of the 19th century, a new movement for the treatment of tuberculosis came into existence; the sanatoria. These were something of a cross between a hotel and a hospital where tuberculosis patients would come and spend many months or even years. Treatment was a combination of sunlight, diet and gentle exercise. It is doubtful whether the sanatoria improved survival of the patients but may have reduced tuberculosis in the community by removing infectious patients, so reducing transmission. Streptomycin, discovered in the USA during 1944 and brought in to clinical use soon after, was the first specific anti-tuberculosis drug. The apparent cure it provided, especially for children dying from tuberculous meningitis, seemed little short of miraculous. But the joy was short lived as many children relapsed after a few months of treatment, because the bacteria had developed resistance to streptomycin. Over the next two decades further anti-tuberculosis drugs were discovered which could be added to the treatment regimen. Some such as pyrazinamide, caused unacceptable side effects in the dosage used and fell out of favour for a time. Others such as ethambutol, though not particularly effective in killing bacteria, were useful in combination with other drugs in preventing the emergence of resistance. Yet others such as ethionamide, and cycloserine, had both poor bacterial killing ability and troublesome side effects, but were useful as reserve drugs for patients who had developed resistant bacteria to the better drugs. In the late 1960s a new and perhaps the most important drug in the treatment of tuberculosis was discovered: Rifampicin. This drug was able to kill the very slowly dividing bacteria, the so-called "persisters" in a way that the other drugs could not. It was found that by combing this drug with at least two others initially, the length of treatment could be reduced to as little as six months. So the new standard of treatment of tuberculosis became isoniazid (H), rifampicin (R),and pyrazinamide (Z) for two months followed by isoniazid and rifampicin for four months. Before the discovery of specific antibiotics for the treatment of tuberculosis, there was no cure. Mortality of those with pulmonary disease (disease of the lungs) was about 50%. The introduction of anti-tuberculosis drugs in the 1950s and the development of the various drug regimens meant that by the 1980s there was a 98% chance of cure. Unfortunately the very success of the drug treatment of tuberculosis has been the catalyst for the emergence of a new wave of drug resistance. Patients have been allowed to take their medication at home completely unsupervised. The experience of the early single use of streptomycin taught us that taking one drug on its own for tuberculosis would lead to drug resistance. There is a danger that if the patient is sent home with three separate drugs, he or she might take a single drug at a time. The End.
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