By Institute of Medicine
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Additional resources for Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary
Murray also presented XDR TB outcome data published over the past year. These data showed that the failure rate for treatment of XDR TB ranges from about 35 percent to about 80 percent, mainly in non-HIVprevalent populations. Murray hypothesized that the failure rates in Africa and in parts of Eastern Europe where HIV is more prevalent would likely be even higher. She noted that XDR TB cases, which are not treatable with fluoroquinolone, usually are not treatable unless a second injectable drug is available.
Treatment Murray discussed the inadequacies of current TB treatment strategies and how these inadequacies lead to increases in drug resistance and transmission. She cited estimates that of the half million MDR TB cases and 40,000 XDR TB cases newly diagnosed in 2006, only a small proportion are being treated through either GLC-approved or non-GLC-approved treatment programs (see Figure 3-1). Even among the small proportion of patients that are being treated, many are not receiving drugs that actually address their drug resistance profile, and therefore their treatment is ineffective.
Gandhi gave further evidence that XDR TB is being transmitted rather than acquired in Tugela Ferry by expanding on Friedland’s comments regarding the Tugela Ferry epidemic. In 2006, Gandhi’s group recorded the first 53 cases of XDR TB in South Africa. , 2006). First, the XDR TB was highly fatal, with 98 percent of patients dying within a median of just 16 days after sputum collection. , 2006). Second, because about half of these patients had never before been treated for TB, and 85 percent had a genetically similar strain, resistance was likely transmitted rather than acquired.
Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary by Institute of Medicine