1,721,124 research outputs found
A new free-cost e-service supporting clinicians to manage their difficult-to-treat TB cases: The ERS-WHO TB consilium
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Crossborder travel and multidrugresistant tuberculosis (MDRTB) in Europe
No full textThe number of international migrants worldwide has continued to grow rapidly over the past fifteen years and the trend is expected to continue, making the health matters associated with migration a crucial public health challenges faced by governments and societies. Multidrug-resistant tuberculosis is a paradigm of transmissible diseases that do not respect borders and poses a multifaceted and complex challenge on migrant health. The guiding principles for the health response are the respect of equity and human rights as well as the accurate analysis of epidemiological trends and determinants of TB in migrants. The action framework "Towards tuberculosis elimination: an action framework for low-incidence countries" includes regulations for cross border migration among the top eight interventions for TB elimination in low incidence countries. Political commitment is the essential requirement, and currently, the limiting factor, to draft regulations for cross-border collaboration, establish cross-border referral systems with contact tracing and information sharing. The e-platform TB Consilium hosted by European Respiratory Society in collaboration with World Health Organization - Euro is an example of a tool that can be used to exchange information for clinical management and surveillance
A new free-cost e-service supporting clinicians to manage their difficult-to-treat tuberculosis cases:The European Respiratory Society-World Health Organization tuberculosis Consilium
Full text linkThe pandemic of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB), respectively, defined as resistance to isoniazid and rifampicin, and to at least one fluoroquinolone and one injecTable second-line anti-TB drug in addition to isoniazid and rifampicin, is attracting more and more interest1,2,3.
Over 480,000 cases of MDR-TB (and 100,000 of rifampicin-resistant TB)1 are challenging physicians all over the world, as treating these cases is long, expensive and clinically complicated2,3,4,5,6,7,8,9,10. Furthermore, the results are still largely suboptimal with success rates in the order of 50 per cent in MDR-TB patients, which become as low as 20 per cent (with 15% failure/relapse and 35% death rates)2,3,10 in cases harbouring Mycobacterium tuberculosis strains with resistances beyond XDR2,3
Management of drug resistantTB in patients with HIV co-infection
No full textIntroduction: Multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB) are major public health concerns worldwide. Their association with HIV/AIDS infection has contributed to the slowing down of TB incidence decline over the last two decades, therefore representing one of the most important barriers to reach TB elimination. Areas covered: The aim of this manuscript is to critically review the recent scientific evidence on the management of drug-resistant TB (essentially MDR- and XDR-TB) in subjects coinfected with HIV, focusing on the two new recently-approved anti-TB drugs delamanid and bedaquiline. The medical search-engine PubMed was used, selecting the time-period January 2013 - February 2015, and using the following Keywords: drug-resistant TB, multidrug resistant TB (or MDR-TB), extensively drug-resistant TB (or XDR-TB), delamanid and bedaquiline. Expert opinion: The TB/HIV co-epidemic can be faced by implementing the 12 TB/HIV collaborative activities recommended by the World Health Organization. They are focused on the systematic screening of individuals to detect the Mycobacterium tuberculosis infection in HIV-positives, as well as HIV infection in TB patients in order to ensure a rapid initiation of the anti-retroviral therapy (ART). The clinical and public health management of HIV-positive individuals with MDR-TB is complex and expensive, given the cost of second line anti-TB drugs (including the new drugs, delamanid and bedaquiline) and ART. Political commitment and more investment to identify shorter, cheaper and effective anti-TB and HIV regimens as well as better diagnostics and, hopefully, a vaccine will contribute to boost the efforts to eliminate TB
Compassionate and optimum use of new tuberculosis drugs
No full textCaitlin Reed and colleagues' description of a severe case of extensively drug-resistant tuberculosis emphasises the emerging issue of access to newly developed second-line drugs for difficult-to-treat or even untreatable tuberculosis cases1 and 2 from the perspective of both affected patients and health-care providers.
As the authors correctly point out, the potential benefits of accessing effective treatment go beyond the individual, and extend to public health because of the risk of transmission of a potentially lethal strain. Our understanding is that the reason for denial of delamanid to a patient already treated with bedaquiline was based on existing policies on the rational use of new drugs.3 and 4 Recent WHO guidance stated that there are no data on the simultaneous use of bedaquiline and delamanid in the same patient and that until such data become available, no recommendation on their joint administration is possible. However, the policy guidance, although accounting for the potential additive cardiac toxic effects, and aimed at minimising harms to those treated within a public health perspective, did not forbid the combined use of the two drugs in individual cases.
We recall that when a similar discussion took place about allowing procurement of second-line antituberculosis drugs at discounted prices via the Green Light Committee in the context of the risk of increasing the prevalence of drug resistance, important organisations were against it. Once again, we need to balance the patient's right to access a new, potentially life-saving drug against the risk of unknown, potentially life-threatening, adverse events, which might severely affect its future use.
Similar cases,2 although sporadic, will probably appear again in the future. In our opinion, since the rational use of new drugs (aimed at protecting both the patient and the drug) is an internationally agreed milestone, the simultaneous use of delamanid and bedaquiline might be considered if several conditions are met: an effective treatment cannot be designed by using only one new drug in addition to the optimised background regimen, the clinical centre is qualified, informed consent and pharmacovigilance are in place, and new drug use is supported by expert opinio
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