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March 19, 2014

Drug-Resistant TB is Global Threat

by Joe DeCapua

The medical aid group -- Doctors without Borders -- warns that drug-resistant tuberculosis has become a global threat. It says despite the growing number of cases, there are no effective treatments.


Doctors Without Borders has released a Crisis Alert called The New Face of an Old Disease. The group – also known by the French acronym MSF – says urgent action is needed to solve the problem.

Dr. Phillip Du Cros, a TB advisor for the group, said, “In MSF’s experience, we are seeing MDR-TB – or multi-drug resistant TB – in more and more countries and in more numbers in our programs.”

There are about 500,000 new cases of MDR-TB every year.

Du Cros said that it’s hard enough dealing with MDR-TB, let alone an even stronger strain of the bacteria that causes XDR-TB or extensively drug resistant tuberculosis. He tells the story of an infected child in Central Asia.

“After a year of treatment, she was failing treatment with all the drugs that we have. So this poor child had gone through treatment where she had suffered from nausea almost every day and she was going deaf from one of the drugs. She was having to take over seven different drugs every day, all with different side effects. And despite trying to take all of this treatment she was failing treatment and showing the limits of the treatment that we have available currently,” he said.

Standard TB drugs do not work against the new forms of the disease. Treatment for MDR-TB could last two years, during which time a patient may swallow 10,000 pills and have daily injections for eight months. And after all that, it may not work.

Du Cros said, “I think the main reason this has got to be a big problem is that although we’ve made some progress tackling TB, in recent years the global community has turned away from investing in improving on what we can do with TB. We’ve been satisfied with old answers. The reality is that we don’t currently have the answers that will solve the problem of TB. We don’t have actually effective treatments in new regimens that will actually tackle the large epidemic of multi-drug-resistant TB.

Bacteria can build resistance when TB patients fail to complete their drug regimen – and when countries do not strictly control the use of medications.

“It’s a global problem, which the global community needs to take responsibility for. Not just international organizations like our own or the World Health Organization, but I think also governments and pharmaceutical companies and academics. There are maybe lots of good individual initiatives, but I think as a global community we really need to come together urgently and look at how we can have faster solutions that are going to deliver a real change at ground level for this epidemic,” he said.

The solution, he said, is a much shorter, more effective treatment. Currently, there are only about five to eight drugs used to treat resistant TB depending on the regimen needed. The two latest drugs available are actually the first new TB medications developed in 40 years.

“Although that’s cause for optimism,” he said, “we still don’t know how to use those drugs in new regimens. And so we’re limited by adding them to a regimen that is already highly toxic and difficult for patients to take.”

Dr. Du Cros added if a global investment is not made to address the epidemic there will be a price to pay.

“As an example, in the United States in the early 90s, there was an outbreak of multi-drug resistant TB. And as a result of a few hundred cases the public health program invested nearly one billion [U.S.] dollars. That number of patients is not even a third of what we see in one of our programs in one country. If we don’t start to step-in early to deal with the problem now, you can multiply that figure by a huge number that you can pluck out of the air.”

The Doctors without Borders alert said, “With only one in five people in need receiving treatment, the fatal, airborne disease is left to spread indiscriminately.”