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Study: Millions of TB Deaths Could be Averted with Shorter Therapy


Millions of people die from tuberculosis every year, say experts, because the cure is too long and complicated. But a new study suggests that more people would be helped by shortening the treatment time endorsed by the World Health Organization (WHO).

Tuberculosis is a stubborn disease. Cure requires taking up to four antibiotics daily for a six-month period. Because patients start to feel better soon after they begin treatment, and taking the pills gets to be a nuisance, many patients stop taking them.

But failure to finish all of the medication as prescribed has resulted in TB strains resistant to certain antibiotics.

To make sure this does not happen, the WHO endorsed a strategy in the 1990s called Directly Observed Therapy, in which social workers watch patients take their pills. But the non-compliance rate remains high.

To try to solve the problem, experts have been studying ways to shorten treatment time.

Several studies have shown that treatment times of as little as two months appear to be just as effective as six-month treatments.

Harvard University International Health Professor Joshua Salomon and colleagues conducted a study of the TB epidemic in Southeast Asia, where one-third of the global cases and deaths occur.

The investigators used a model to project what the TB epidemic would look like using a two-month treatment course and a standard six-month course, and found the shorter course to be superior.

"If we get them to the finish line in two months instead of six months, we're likely to see more patients cured, fewer patients forming a pool of infectious cases that can pass on the infection to others," said Salomon. "And when we translate that into benefits in terms of reduced, new cases at the population level and reduced deaths, we see quite an enormous impact."

If adopted by Directly Observed Therapy, a two-month course of antibiotics could double or even triple the decline in new cases and deaths caused by tuberculosis. Under the model, the benefit would be seen between 2012 and 2030.

But the calculation assumes that a new anti-TB drug is developed and in wide use by 2012.

The study on shorter course therapy for tuberculosis was published in the online journal Public Library of Science Medicine.

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