TB is curable

Mar 24, 2009 Editorial

As our extended feature in our Sunday edition noted, today is World TB Day. Long dreaded as a killer disease, we want to emphasise that TB is curable – and has been since the 1940s – but that it remains a scourge primarily due to a lack of discipline in those who are infected to maintain the prescribed regimen of treatment.

The World Health Organisation’s (WHO) slogan from last year that continues to this year – I am stopping TB – is therefore very apropos since it highlights the personal responsibility at the heart of eradication efforts.
World TB Day is observed each year on March 24 to commemorate the date in 1882 when Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis (MT), the bacterium that causes tuberculosis (TB).
Spread from breathing-in air contaminated by bacteria exhaled by patients, the infection rate is extremely high. An estimated two billion persons – one-third of the world’s population – are infected with M. tuberculosis. In 2006, approximately 9.2 million persons became ill from TB, and 1.7 million died from the disease.

In the early days after Koch’s discovery, isolation of patients in “Sanatoriums” became the standard treatment until 1943 when the antibiotic streptomycin was discovered. Today, the drugs used in the fight against TB are Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA), Ethambutol (EMP), and the old standby Streptomycin (STREP). During treatment, a patient will take a combination of these drugs because the TB bacteria may be resistant to one or more of the drugs. It is only through the use of multiple kinds of antibiotics that you can be sure to kill every bacterial cell.
These short-course anti-tuberculosis drugs are normally prescribed for a period between six and eight months. It is critical to take the prescribed amount of each at the prescribed intervals, and for the prescribed length of time. If a patient takes the drugs for the full length of time prescribed by the doctor, he/she will be cured.

But herein lays the problem: most patients give up after two to three months. The MT, as a living creature, adapts to its environment by mutating and the resultant strains become immune to the drugs. The disease is said to be Multi-Drug Resistant TB (MDR-TB) when it is resistant to at least two of the first line drugs used: Rifampicin and Isoniazid.
The Directly Observed Therapy Short-Course (DOTS) strategy was introduced worldwide in the 1990s to overcome the problem of patients not taking their medicine as prescribed. In this simple but tedious process, the ingestion of every dose of medication is directly observed. And this is where if everyone connected with TB patients supports the health workers in charge of DOTS to ensure patient compliance, the disease would be drastically reduced.

Last month there were some findings reported in the Journal of Science that offer hope that a treatment might be in the offing that would eliminate the extensive time-frame of the present regimen. Researchers began with the knowledge that MT contains a certain enzyme that renders the penicillin family of antibiotics drugs useless.
But there are different antibiotics that can block that enzyme, called beta-lactamase. One, named clavulanate, has long been sold as part of the two-drug Augmentin combination that is widely used for various children’s infections.
The research team tested whether administering clavulanate might make MT vulnerable to other antibiotics — and found a combination that in laboratory tests blocked the growth of thirteen different drug-resistant TB strains.

The combination of Clavulanate to drop MT’s enzyme shield, plus a long-sold injected antibiotic — meropenem, part of that penicillin-style family — that then attacks the bacteria, provided an effective “one-two” knockout punch.
What happens in a lab does not necessarily work in people. Still, the findings were so compelling that two teams of U.S. researchers — from the National Institutes of Health and New York’s Montefiore Medical Center — are already planning small patient studies in South Korea and South Africa. They hope to begin those studies later this year.
We wish the researchers well in their heroic efforts, but in the meantime let us all become part of our national DOTS program to continue reducing TB in Guyana.

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