Drug-resistant tuberculosis: time for visionary political leadership

Abstract

Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans.

The Political and Ethical Challenge of Multi-Drug Resistant Tuberculosis

“…Ten other drugs are in late stage clinical trials (although 6 of these are repurposed). There are also 10 candidate vaccines and 2 immunotherapeutic agents in late clinical trials (Abubakar et al 2013). …”

“…Leading experts point to recent progress in developing new agents, but agree that further effort is needed (Dheda et al 2014;Zumla et al 2014;Abubakar et al 2013). We believe that this is where bioethics comes in, because it can offer important perspectives that are not tied to a particular solution and help us to keep what is ethically important in focus-promoting global equity by reducing poverty, optimising public health and preventing the spread of disease.…”

Synthesis of New Mannich Products Bearing Quinoline Nucleous Using Reusable Ionic Liquid and Antitubercular Evaluation

“…India and China together account for 40% of total cases [2] that represent that TB is no more disease of rich countries. Moreover, development of new virulent forms of TB, such as multidrug resistant ([MDR-TB, resistant to at least two frontline drugs such as isoniazid (INH) and rifampin (RIF)]) and extremely drug resistant (XDR-TB), and its synergistic effects with human immunodeficiency virus (HIV) have become a major threat to human kind [3]- [6]. TB is at its peak recent years, largely owing to HIV infection, immigration, increased trade, and globalization [7].…”

Successful Treatment of Rifampicin-resistant Intraocular Tuberculosis

“…5 With rising incidence of MDR-TB, TB remains a major public health challenge globally in 2013. 6 Only 5% cases of TB get tested for drug resistance worldwide. Mutation at the 516 codon is well documented for resistance to rifampicin from culture isolates from pulmonary sites.…”