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Short-term therapy of multi-drug resistant tuberculosis is not advisable in this country


Multi-resistant tuberculosis pathogens in Europe cannot be treated with short-term therapy
Infections with multi-resistant tuberculosis pathogens are becoming increasingly common. The treatment is "rich in side effects, expensive and, above all, lengthy," reports the German Center for Infection Research (DZIF). Although the World Health Organization (WHO) has been recommending short-term therapy for affected patients since 2016, the DZIF scientists from the Borstel Research Center warn that such short-term therapy can only be used successfully in Europe in a few cases.

Multi-resistant tuberculosis pathogens are an increasing challenge in medicine. For example, "Antibiotic-resistant strains of tuberculosis bacteria have spread dramatically in recent decades," reports the DZIF. In some countries in Eastern Europe, more than 40 percent of all tuberculosis cases are caused by multi-resistant bacterial strains (MDR-TB). The recommended short-term therapy of the WHO with the combined use of different medicines is not helpful according to the current study results of the DZIF experts. Rather, individual therapeutic approaches are offered.

WHO recommends short-term therapy
For a long time, the WHO had recommended that patients with multi-resistant tuberculosis infection (MDR-TB) be given at least four different medications per day over a period of 20 months. However, after studies from Bangladesh, Niger and Cameroon recently showed that with a certain combination therapy of tuberculosis medications (initially seven different preparations in combination), only nine to twelve months of treatment are enough to cure more than 80 percent of all affected patients the WHO made its recommendation. Since May 2016, short-term therapy has been advised for the affected patients in all countries, as long as the bacteria are sensitive to all medications used in the treatment.

Particularly many resistant pathogens in Europe
However, according to the DZIF scientists, the WHO recommendation cannot be applied to Europe. In recent years, the researchers have analyzed the spread of multidrug-resistant strains of tuberculosis bacteria in Europe more closely and found that "the bacteria that are spreading in Europe are resistant to a particularly large number of antibiotics." In a current study, the scientists compared now the level of antibiotic resistance of tuberculosis bacteria in more than 1,000 European MDR-TB patients.

Short-term therapy unsuitable in Europe
The evaluation showed that over 92 percent of all affected patients in Europe are not eligible for short-term therapy because the bacteria are already resistant to at least one of the drugs, according to the DZIF. Professor Christoph Lange, head of the study at the Borstel Research Center, emphasizes that "without a detailed knowledge of the antibiotic resistance of tuberculosis bacteria, no patient in Europe should receive short-term therapy".

Risk of further resistance
"If individual drugs are not effective in therapy, this leads to a further development of antibiotic resistance," warns Professor Lange. Instead of uniform treatment, individual therapies would lead to better treatment results. The researchers are currently working on tailor-made therapies and developing biomarkers to individually determine the duration of treatment that is necessary for a cure, the DZIF continues. (fp)

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Video: Multidrug-resistant Tuberculosis Diagnosis. Pennan Barry, MD, MPH (September 2021).