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Effectiveness of Four-Drug TB Treatment Confirmed

  • Vidushi Sinha

An x-ray of the lungs of a TB patient

An x-ray of the lungs of a TB patient

One of the biggest challenges in fighting tuberculosis comes from new drug-resistant strains of the disease. And one of the main reason those strains have developed is that TB patients often don't take their standard, 14-pill, course of medication as instructed. Now, as Vidushi Sinha reports, a new study finds that a simpler approach - combining four TB drugs into one pill - is just as effective in treating this global killer.

For about a decade now the World Health Organization has recommended treating tuberculosis by using a four-drug, fixed-dose combination of medication - which has the same amount of pharmaceutical ingredients as the 14 pills that have traditionally been used.

But the logic of fewer pills - a simpler routine for sick patients - has not yet sunk in among many doctors.

For a variety of reasons, health professionals treating TB have resisted prescribing fewer pills.

But a new study in the high-TB-incidence areas of Africa, Asia, and Latin America confirms that the four-drug combination of pills is just as effective as the 14-pill regimen.

Dr. Christian Lienhardt conducted the the research in several countries comparing the new and old treatment regimens.

"It is true everywhere in the world patients, don’t like to take too many pills and if you have to take 14 pills every day for 6 months - you have the choice for four, then I will prefer 4 and lot of people will prefer 4," said Dr. Lienhardt.

But Lienhardt says the four-pill treatment has been resisted because many care providers intuitively doubt it would be as effective.

"There is a type of a common sense and mainly among the health staff that when you take the older drugs that you know each one of them had a very, very good activity and when you combine maybe there is a way to lose that activity," he said. "That is a type of common sense that might unfortunately take place mainly among the care providers rather than the patients."

Tuberculosis is an aggressive bacterial disease that attacks the lungs and spreads rapidly among people with weakened immune systems. It kills nearly two million people worldwide every year . Experts say it’s treatable if medication is taken as prescribed.

In the classical treatment, TB patients are usually prescribed 12 to 20 pills daily depending on their weight. Having the combination drug would improve the chances that patients would finish taking their entire dose.

In the 11-country study by Leinhardt and his colleagues, patients were divided into two groups. One got the combination pills and the other took the same drugs in individual pills, clinical trial found the combination pills to be equally effective.

"We need to really make this case very strongly that using these types of drugs is having the same efficacy as the normal drugs," said said Dr. Lienhardt. "But again it is a very good tool to avoid the emergence of drug resistance."

More powerful medicines are needed for drug-resistant strains, and some are even hard to treat with any drugs.

Dr. Lee Reichman has worked to control TB for 40 years.

"Multi-drug resistant TB and extensively drug resistant TB are failures of the system," said Dr. Reichman. 'TB is treatable and preventable. And if we find TB properly and treat TB properly, a: they are cured, and b: they don't develop drug resistant TB, whether it be multi-drug or extensive drug."

Researchers aim to popularize the four-drug fixed-dose combination pills among international public health officials, policy makers, and patient’s organizations as part of the continuing campaign to eradicate TB.