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Title: Focus on Prevention Needed to Combat Drug-Resistant Tuberculosis
URL: http://www.pslgroup.com/dg/2286CE.htm
Doctor's Guide
August 13, 2008

ARLINGTON, Virginia -- August 13, 2008 -- In the first statewide study of extensively drug-resistant tuberculosis (XDR TB) in the United States, California officials have identified 18 cases of the dangerous and difficult-to-treat disease between 1993 and 2006, and 77 cases that were one step away from XDR TB. The study appears in the August 15 issue of Clinical Infectious Diseases, now available online.

The authors of the new study evaluated drug susceptibility data of multidrug resistant tuberculosis (MDR TB) cases identified by the California TB Registry between 1993 and 2006, looking for cases that fit the XDR TB definition.

Over the course of the study, TB outcomes improved. Deaths declined among XDR TB cases identified after 2000. However, the authors wrote, strategies must be implemented to identify and cure MDR and pre-XDR TB cases before they develop into XDR TB. Modelling studies suggest that unless evolution of MDR into XDR is slowed, XDR cases could increase exponentially. Prevention is more cost-effective than treatment, they noted.

"Globally, XDR TB has resulted from a combination of poor TB control practices, poor adherence to medications, inappropriate use of second-line drugs, lack of laboratory capacity to culture TB or assess drug susceptibility, and high HIV prevalence," said lead author Ritu Banerjee, MD, PhD, University of California at San Francisco, San Francisco, California. "In order to prevent an escalation in XDR TB, we need to ensure adherence to the cornerstones of TB management, which include directly observed therapy, isolation of infectious cases, and contact investigations. We also need to institute routine, rapid, and standardised methods to assess drug susceptibility of TB isolates," she concluded.

SOURCE: Infectious Diseases Society of America

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