European group offers guidance for treating MDR, XDR-TB

TB chest x-ray
TB chest x-ray

Chest x-ray shows lungs infected with Mycobacterium tuberculosis., stockdevil / iStockphoto

A European clinical network for tuberculosis (TB) research has published what is being billed as the first consensus guidelines for treatment of multidrug-resistant and extensively drug-resistant TB (MDR-TB and XDR-TB).

The guidelines from TBnet are intended for use in the World Health Organization's (WHO's) European Region, which has the highest burden of drug-resistant cases. They were released yesterday in the European Respiratory Journal.

In a statement, the European Lung Foundation said the guidelines "mark the first time that physicians who treat patients with multidrug- and extensively drug-resistant TB have reached a consensus on important areas of patient management where scientific evidence is inconclusive."

The 41-page guidelines article says the management of patients with MDR- and XDR-TB is extremely complex. "The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates," it states.

The guidelines were released in connection with today's observance of World TB Day.

In a statement related to World TB Day, the WHO's Regional Office for Europe said 15 of the 27 countries with a high burden of MDR-TB are in the European Region. Fewer than half of the estimated number of cases are diagnosed, and only half of diagnosed cases are cured, the agency said.

32,000 cases of MDR-TB in children

In related news, a team of Boston researchers from Brigham and Women's Hospital (BWH) and Harvard Medical School estimated that nearly 1 million children contracted TB in 2010 and that about 32,000 cases were MDR. The estimate was published today in The Lancet.

In a systematic literature review of the risk of MDR-TB, the authors found 97 studies that met their criteria, and 31 reported the risk for both children and adults. They determined that the setting-specific risk of MDR-TB was nearly the same in children and treatment-naive adults. From the setting-specific risks, they estimated that about 999,792 children contracted TB in 2010 and that 31,948 had the MDR form.

In a BWH press release, Ted Cohen, MD, DrPH, co-senior author of the study and HMS associate professor of at BWH, said there have been no previous estimates of the MDR-TB burden in children. "Our estimate of the total number of new cases of childhood TB is twice that estimated by the WHO in 2011 and three times the number of child TB cases notified globally each year," he said.

"Our findings underscore that many cases of tuberculosis and multidrug-resistant tuberculosis disease are not being detected in children," the authors conclude. Their study is one of 11 TB-related articles released by The Lancet today.

Funds for finding new TB drugs

In other developments, the Seattle-based Infectious Disease Research Institute (IDRI) announced today that it has been awarded a $3.4 million grant extension from the Bill & Melinda Gates Foundation to continue the quest for new TB drugs.

The grant was awarded to Tanya Parish, PhD, IDRI vice president of drug discovery, the institute said in a press release. The funding supplements a grant awarded in 2010, bringing the total amount to $7.8 million.

Parish said IDRI, with its partners in the Lilly TB Drug Discovery Initiative and the TB Drug Accelerator, has screened several hundred thousand compounds and has identified "a number of promising compound series." The new funds will enable IDRI to expand its exploration of these compounds and others, she said.

See also:

Mar 23 Full text of guidelines in European Respiratory Journal

Mar 23 European Lung Foundation press release

Mar 24 WHO European Region press release

Mar 24 Lancet abstract on MDR-TB in children

Mar 23 press release on Lancet study

Mar 24 IDRI press release

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