Improving Treatment Outcomes for Tuberculosis

Major issues are currently associated with Tuberculosis (TB) treatment, particularly in patients infected by Multidrug Resistant Tuberculosis/Extensively Drug Resistant Tuberculosis (mdr-TB/XDR-TB) resistant mycobacteria. A new threat recently reported in various Asian countries is totally Drug Resistant Tuberculosis (TDR). The presence of such Mycobacterium tuberculosis strains is disturbing also for the reasons they spread beyond the continent of Asia. The currently recommended tuberculosis treatment regimen is not well received by patients due to its minimum six-month, complexity, and common adverse events. The prevalence of MDR-TB and XDR-TB are inversely correlated with the quality of TB control and the proper use of second-line anti-TB drugs. Moreover, cost is extraordinary high. Since the mid-1960s only two new anti-TB drugs, bedaquiline and delamandine, have come to market; however, these drugs are not available in many regions and are limited to severely resistant cases. Currently, new derivatives such as spectinoamide are of interest in tuberculosis treatment. In vitro results and animal studies are used to aid in drug development. There is an urgent need for treatment improvement through enhancement of existing agents. Namely, individual differences in absorption and excretion of the primary anti-TB drugs, isoniazid and rifampin, require consideration. Recently, several studies attempted to evaluate the effect of anti-TB drug concentrations on treatment outcomes. Authors showed that 50-76% of the tested patients had low concentrations of INH (Isoniazid) and RMP (Rifampin). Because Therapeutic Drug Monitoring (TMD) was performed in small numbers of selected patients with comorbidities or slow treatment responses, the studies did not clearly demonstrate the effect of low drug levels on treatment outcomes. Future coordinated research is required. New molecular tests allow for research using supervised, individualized treatment of tuberculosis. In addition, effective tuberculosis outcomes require coordinated action multiple parameters for patient detection through implementation of rapid microbiological and clinical tests as well as reliable drug resistant tests of Mycobacterium tuberculosis. This leads to a break in the chain of transmission, and prevents the spread of disease in community. Education plays in important role for patients and families concerning the causes of disease and prevention methods. Additionally, medical staff should also themselves improve the level of diseases knowledge. Behaviour changes in tuberculosis infection control among medical personnel is also required. Keep in mind that one of the reasons for the relapse of tuberculosis is its disregard. *Corresponding author: Zwolska Z, Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 26 Płocka, 01-138 Warsaw, Poland, Tel: 48-22-43-12-182; Fax: 48-2243-12-182; E-mail: [email protected] Received May 22, 2017; Accepted June 12, 2017; Published June 22, 2017 Citation: Zwolska Z (2017) Improving Treatment Outcomes for Tuberculosis. J Bioequiv Availab 9: 442-446. doi: 10.4172/jbb.1000341 Copyright: © 2017 Zwolska Z. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Zwolska Z (2017) Improving Treatment Outcomes for Tuberculosis. J Bioequiv Availab 9: 442-446. doi: 10.4172/jbb.1000341 J Bioequiv Availab, an open access journal ISSN: 0975-0851 Volume 9(4): 442-446 (2017) 443 6934 up to 10,585 between 2009 and 2013. The European Centers for Disease Prevention and Control reported 3522 patients with MDR/XDR living in the Ukraine in 2012, compared to 1421 in all European Union/ European Economic Area countries combined [5]. The WHO estimated 9.6 million new global TB cases in 2016: 5.4 million males, 3.2 million females, and 1.0 million children. Almost 80% of active TB cases and 95% of TB deaths occur in lowor middleincome countries [6]. The disease still poses a serious public health problem worldwide and remains the leading cause of death due to a single infectious agent [7,8]. Despite that epidemiology of TB in Poland since 1945 has been constantly improving, in 2015 the incidence of TB in Poland was higher than the mean incidence in the European Union and European Economic Area (17.4 v 12.7 per 100,000). Tuberculosis remains the most common single cause of death due to an infectious agent in Poland [9,10]. Treatment of Tuberculosis Early diagnosis and effective treatment of TB and are key elements in reducing infection transmission. The current first-line treatment for TB is a multidrug regimen that consists of isoniazid, rifampicin, pyrazinamid, and ethambutol (HRTZE). This drug course must be maintained for at least six months to achieve a high cure rate. The WHO has set an international target value for favourable treatment outcomes at 85% published recommendations for assessing outcomes of tuberculosis treatment in the 1990's, with a revised version published in 1998 [11,12]. However, in many highly developed countries with good treatment facilities, outcomes have still not reached the targets set by the WHO. Poland belongs to the group where result did not meet the WHO requirements. In 2015, the success rate of the pulmonary TB treatment in Poland was 57% and Extrapulmonary Tuberculosis (ExtraTB) treatment was 57.6% [9]. Treatment of MDR-TB is difficult as current regimens, when compared to those used to treat drug-susceptible TB, are less effective but more costly, toxic, and lengthy Due to the expanded use of secondline drugs (aminoglycosides, fluoroquinolones, cycloserine, etionamide, and others) in patients with MDR TB, the prevalence of XDR TB is increasing. In 2000, the Green Light Committee (GLC) was formed within the Stop TB Partnership and WHO in order to increase access to highquality, second-line anti-TB drugs at low prices, to prevent additional drug resistance, and to contribute evidence toward policy development. By 2011, 255 project applications to the GLC had been approved, covering more than 130,000 patients with MDR TB [13,14]. The currently available TB treatment regimen presents a number of weak points: duration and complexity of therapy, decreased adherence to treatment, common adverse events in response to anti-TB drugs, and increasing incidence of MDR and XDR tuberculosis [15]. There is an urgent need to improve treatment by either enhancing the applications of existing agents or introducing new drugs. Only two new anti-TB drugs, bedaquiline and delamandine, have come to the market since the mid-1960s, and the use of these medicines is currently limited to the most severely resistant cases. However, these drugs are not available in many countries. Current antibiotic-based drug resistant TB treatment strategies are arduous for patient causing many adverse effects including hearing impairment and psychosis, as well as some practical problems for families, communities, health systems, and livelihoods.