July 6 -- Simpler and shorter treatment with antibiotic drugs could help prevent full-blown tuberculosis in millions of people worldwide infected with the bacterium that causes TB, especially those also infected with HIV, researchers report.
TB, or tuberculosis, is the leading cause of death among people co-infected with HIV, the virus that causes AIDS. About half a million people with both infections die worldwide every year.
The new study by an international team of scientists included 1,148 South African men and women infected with the TB bacterium and HIV, who were followed for up to six years to see whose TB infections stayed dormant.
It found that the most streamlined combination treatment -- a high dose of 900 milligrams each of the newer antibiotic rifapentine (Priftin) and the traditional anti-TB antibiotic isoniazid once weekly for three months -- worked as well or better than the current gold standard of care of 300 mg of isoniazid taken daily for six months or longer.
Of the study volunteers, about 3.1 percent on the shorter drug regimen developed active TB or died each year, compared to 3.6 among those on the standard daily regimen. Without treatment, researchers estimated that the mortality rate would have doubled.
Compliance with the drug regimen was also 95 percent for the shorter regimen, compared to 60 percent that other studies showed for the standard regimen.
The study appears online July 7 in the New England Journal of Medicine.
"This new, simpler treatment regimen with rifapentine and isoniazid is highly effective and could transform therapy for latent tuberculosis in both those co-infected with HIV and those not," senior author Dr. Richard Chaisson, a professor of infectious diseases at the Johns Hopkins University School of Medicine and founding director of its Center for Tuberculosis Research, said in a Hopkins news release.
"New treatment options are urgently needed to help control TB globally, and simpler regimens will substantially increase the number of people receiving therapy," Chaisson added.
He noted that fewer than 1 percent of those infected and most likely to develop full-blown TB receive drug treatment because of factors such as inconvenience, drug side effects and difficulty finding nearby health clinics.
http://www.drugs.com/news/new-combo-therapy-may-prevent-tb-save-lives-hiv-32368.html
Showing posts with label isoniazid. Show all posts
Showing posts with label isoniazid. Show all posts
Monday, 18 July 2011
Monday, 23 May 2011
TUBERCULOSIS: TB Drugs Show Surprising Equality
Michael Smith : May 19, 2011
DENVER -- Two rifamycin derivatives had equal efficacy against pulmonary tuberculosis in an international, phase II trial, a researcher said here.
Rifapentine (Priftin) and rifampin (Rifadin, Rimactane) showed equal activity when they were added to standard therapy during the first eight weeks of treatment, according to Susan Dorman, MD, of Johns Hopkins University.
But the result was surprising because animal studies had suggested that rifapentine would be markedly better, Dorman said in a late-breaking abstract session at the annual meeting of the American Thoracic Society.
The rifamycin derivatives are "key sterilizing components of current standard treatment for active TB," Dorman said. Of those drugs, rifampin is the most widely used, but it may not be the best, she added.
In particular, less rifapentine is needed to inhibit a given amount of Mycobacterium tuberculosis, and it lasts longer in the body than rifampin, she said.
Studies in mice showed that treatment with rifapentine cured TB in three months compared with six months for rifampin, Dorman added. "There is a need for shorter regimens" in humans, she noted.
To test the compound in humans, she and colleagues added either it or rifampin to standard early therapy -- isoniazid (Nydrazid, Tubizid), pyrazinamide, and ethambutol (Myambutol) -- five days a week for eight weeks.
The goal was see if there were differences in the proportion of patients with negative sputum cultures at the end of the intensive phase of treatment, Dorman said.
The researchers also evaluated safety and tolerability, she said.
All told, 531 patients took part, almost half of them in Africa; 255 were assigned to the rifampin arm and 276 to rifapentine. About 70 participants in each arm were either lost to follow up or were found not to be eligible, Dorman reported.
The researchers had expected to see a 15% difference in the rate of culture negativity, Dorman said, but instead the difference was about 3%.
Specifically:
When the sputum samples were analyzed in liquid media, 71.5% of rifampin patients and 75.3% of rifapentine patients had negative cultures after eight weeks.
In solid media, the proportions were 88.9% and 91.9%, respectively.
Neither difference was statistically significant.
Both drugs appeared equally safe and tolerable, Dorman reported.
In the rifampin arm, 15.7% of patients stopped therapy, compared with 14.5% of the rifapentine patients, she said. The rates of adverse events were also similar -- 18.1% for rifampin versus 22.6% for rifapentine -- and 2.8% of rifampin patients reported hepatitis compared with 3.6% of rifapentine patients.
It remains unclear why the expected difference did not materialize, Dorman said, adding that it could be a function of dosing levels or perhaps the fact that both drugs were taken without food.
She noted that the proportion of culture conversions is a surrogate marker for the sterilizing activity of the drugs which may not have been a good reflection of that activity.
The study was supported by the CDC. Study drugs were donated by sanofi-aventis. Dorman said she had no conflicts.
Source reference: Dorman S, et al "A phase II study of a rifapentine-containing regimen for intensive phase treatment of pulmonary tuberculosis: Preliminary results for tuberculosis trials consortium study 29" Am J Respir Crit Care Med 2011; 183: A6413.
http://www.medpagetoday.com/MeetingCoverage/ATS/26575
DENVER -- Two rifamycin derivatives had equal efficacy against pulmonary tuberculosis in an international, phase II trial, a researcher said here.
Rifapentine (Priftin) and rifampin (Rifadin, Rimactane) showed equal activity when they were added to standard therapy during the first eight weeks of treatment, according to Susan Dorman, MD, of Johns Hopkins University.
But the result was surprising because animal studies had suggested that rifapentine would be markedly better, Dorman said in a late-breaking abstract session at the annual meeting of the American Thoracic Society.
The rifamycin derivatives are "key sterilizing components of current standard treatment for active TB," Dorman said. Of those drugs, rifampin is the most widely used, but it may not be the best, she added.
In particular, less rifapentine is needed to inhibit a given amount of Mycobacterium tuberculosis, and it lasts longer in the body than rifampin, she said.
Studies in mice showed that treatment with rifapentine cured TB in three months compared with six months for rifampin, Dorman added. "There is a need for shorter regimens" in humans, she noted.
To test the compound in humans, she and colleagues added either it or rifampin to standard early therapy -- isoniazid (Nydrazid, Tubizid), pyrazinamide, and ethambutol (Myambutol) -- five days a week for eight weeks.
The goal was see if there were differences in the proportion of patients with negative sputum cultures at the end of the intensive phase of treatment, Dorman said.
The researchers also evaluated safety and tolerability, she said.
All told, 531 patients took part, almost half of them in Africa; 255 were assigned to the rifampin arm and 276 to rifapentine. About 70 participants in each arm were either lost to follow up or were found not to be eligible, Dorman reported.
The researchers had expected to see a 15% difference in the rate of culture negativity, Dorman said, but instead the difference was about 3%.
Specifically:
When the sputum samples were analyzed in liquid media, 71.5% of rifampin patients and 75.3% of rifapentine patients had negative cultures after eight weeks.
In solid media, the proportions were 88.9% and 91.9%, respectively.
Neither difference was statistically significant.
Both drugs appeared equally safe and tolerable, Dorman reported.
In the rifampin arm, 15.7% of patients stopped therapy, compared with 14.5% of the rifapentine patients, she said. The rates of adverse events were also similar -- 18.1% for rifampin versus 22.6% for rifapentine -- and 2.8% of rifampin patients reported hepatitis compared with 3.6% of rifapentine patients.
It remains unclear why the expected difference did not materialize, Dorman said, adding that it could be a function of dosing levels or perhaps the fact that both drugs were taken without food.
She noted that the proportion of culture conversions is a surrogate marker for the sterilizing activity of the drugs which may not have been a good reflection of that activity.
The study was supported by the CDC. Study drugs were donated by sanofi-aventis. Dorman said she had no conflicts.
Source reference: Dorman S, et al "A phase II study of a rifapentine-containing regimen for intensive phase treatment of pulmonary tuberculosis: Preliminary results for tuberculosis trials consortium study 29" Am J Respir Crit Care Med 2011; 183: A6413.
http://www.medpagetoday.com/MeetingCoverage/ATS/26575
TUBERCULOSIS: Simplifying treatment for TB without symptoms
May 16 2011
The findings of a large government trial show a treatment regimen that differs from the standard therapy may be effective in treating the latent form of tuberculosis.
About 11 million people in the U.S. are infected with latent tuberculosis, which is symptom-free and is not contagious. Of those, 5 to 10 percent will go on to develop active TB, which can be spread to others and can be fatal if not properly treated.
Researchers looked at 8,000 people with latent TB, mostly in the United States or Canada. They were randomly given one of two treatments- the standard course of therapy, which takes nine months of daily treatment, or a once-weekly treatment for three months. The standard treatment is isoniazid. The experimental regimen combined isoniazid with rifapentine.
"The treatment of latent TB can be shortened from 270 doses to 12 doses, and be just as effective- that's pretty impressive," said Dr. Dean Schraufnagel, president of the American Thoracic Society and a TB expert.
Those on the once-weekly treatment were more likely to complete it- 82% versus the current rate of 69%.
"This new treatment for TB may have great, extraordinary consequences," Schraufnagel said. "I believe this will be a major strategy to control TB, both in the U.S. and worldwide."
Statistics from the CDC show the case count is on the decline, but in 2007, 544 deaths occurred from TB. In 2009, the case numbers were at an all-time low. Asians, African Americans and Native Hawaiians, along with foreign-born individuals, are disproportionately affected more than whites.
“Achieving CDC's goal of TB elimination in the United States means not only treating those individuals who already have TB disease, but also treating those with latent TB infection who are at high risk of developing TB disease and potentially transmitting it to others,” said Dr. Kevin Fenton, Director of CDC’s National Center for HIV-AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP).
“While the number of reported cases of TB disease is currently low, in today's highly interconnected world, we need to guard against a resurgence of TB both at home and abroad,” he added.
Symptoms of TB can include chest pain, a bad cough (possibly with blood), weakness and a fever. While TB usually impacts the lungs, the kidneys, brain and spine may also be affected.
Schraufnagel said people with latent TB who go on to develop active TB won't know it at first.
"They'll develop a little cough- the cough persists," he said. "They think it might be a cold, sometimes they might have a little fever. This cough doesn't go away and after a month or two months, or three months, they may contact a doctor. And even then, they're often treated for a cold or some other thing. Then they would get an X-ray or examine the sputum and make the diagnosis of TB. By that time, those people have infected 10, 20, 30, 40, a lot of new people."
The CDC offers these guidelines as to who should get tested for TB:
- If you've been around someone with active TB disease
- If you have HIV or another condition that makes the immune system weaker
- If you live in a homeless shelter or some nursing homes
- If you are from a country where TB is very common
- If you inject illegal drugs
One-third of the world's total population are infected with TB bacteria, according to the World Health Organization.
It says each person who becomes sick with active TB, if not treated, can infect on average 10 to 15 other people a year.
"It's important to note that the study was conducted in countries which carry a low to medium incidence of tuberculosis,” said Dr. Kenneth Castro, Director, Division of Tuberculosis Elimination, NCHHSTP. "That is primarily in the United States and Canada, and the results can therefore only be applied to these settings. The trial did not include countries with high tuberculosis incidence where the increased risk of re-infection could affect the effectiveness of this regimen."
http://thechart.blogs.cnn.com/2011/05/16/simplifying-treatment-for-tb-without-symptoms/
TUBERCULOSIS: Shorter treatment found for latent tuberculosis (Priftin - Rifapentine)
Thomas H. Maugh II, Los Angeles Times thomas.maugh@latimes.com
May 17, 2011
A cocktail of antibiotics taken for three months works as well as the standard nine-month TB treatment, researchers say. That increases the proportion of people who finish treatment, helping stop the spread of TB.
In what is being hailed as the biggest breakthrough since the 1960s in treatment for latent tuberculosis — noninfectious TB without symptoms — researchers said Monday that weekly doses of a cocktail of antibiotics can cure the infection in only three months as effectively as the standard treatment of daily drugs for nine months.
By reducing the number of pills and shortening the time required for therapy, the new regimen increased the proportion of patients who completed treatment from 69% to 82%. By increasing the success rate of therapy, the regimen should reduce spread of the disease and the risk of inducing resistance to TB drugs, experts said.
"It's very clear that, in this country, if we are going to get rid of TB, we have to do so by preventing people at risk from going on to develop the disease," said Dr. Richard Chaisson of the Johns Hopkins University School of Medicine, the senior author of the study. That can only be accomplished by curing latent TB, he said.
Latent TB refers to infection by the TB bacterium in people who do not have symptoms and cannot infect others. But that latent infection can be converted into an active one by many different factors — at which point the patient becomes infectious.
Although TB control measures in the United States have brought the incidence of the disease to an all-time low of 11,181 cases in 2010, it is estimated that at least 11 million Americans have latent TB.
"The 11 million Americans with latent TB represent a ticking time bomb," Dr. Kenneth Castro, director of the Centers for Disease Control and Prevention's division of tuberculosis elimination, said at a news conference Monday. "They're the source of future TB cases."
Daily doses of the antibiotic isoniazid have been the standard of care for TB for nearly 60 years. But a newer, more potent drug, rifapentine, marketed under the brand name Priftin by Sanofi-Aventis, persists in the body for long periods.
In the study, begun 10 years ago, researchers enrolled 8,053 people with latent TB, most living in the U.S. and Canada, though some were in Brazil and Spain. Half were selected to receive conventional daily isoniazid treatment for nine months and half received a combination of isoniazid and rifapentine weekly for 12 weeks.
In the 33 months of follow-up, seven of those receiving the combination therapy developed TB, compared with 15 of those receiving isoniazid alone, coauthor Dr. Timothy Sterling of Vanderbilt University reported at the American Thoracic Society International Conference in Denver.
The combination "works certainly as well as isoniazid, and actually a little bit better," Chaisson said.
One complication is that the treatment cannot be given simultaneously with drugs for HIV infections, a significant drawback because many patients in the developing world have both diseases. Rifapentine stimulates the production of liver enzymes that break down many drugs, including protease inhibitors used for HIV treatment. The enzymes reduce levels of the drugs by as much as 95%, making use of the drugs at the same time pointless.
Chaisson said the team was now testing a regimen in which protease inhibitor treatment is halted for a month and rifapentine given daily. Normal HIV treatment is then resumed. Results from that study should be published soon.
The trial was sponsored by the CDC, and results have been submitted for publication.
http://www.latimes.com/health/la-he-latent-tb-20110517,0,2486639.story
May 17, 2011
A cocktail of antibiotics taken for three months works as well as the standard nine-month TB treatment, researchers say. That increases the proportion of people who finish treatment, helping stop the spread of TB.
In what is being hailed as the biggest breakthrough since the 1960s in treatment for latent tuberculosis — noninfectious TB without symptoms — researchers said Monday that weekly doses of a cocktail of antibiotics can cure the infection in only three months as effectively as the standard treatment of daily drugs for nine months.
By reducing the number of pills and shortening the time required for therapy, the new regimen increased the proportion of patients who completed treatment from 69% to 82%. By increasing the success rate of therapy, the regimen should reduce spread of the disease and the risk of inducing resistance to TB drugs, experts said.
"It's very clear that, in this country, if we are going to get rid of TB, we have to do so by preventing people at risk from going on to develop the disease," said Dr. Richard Chaisson of the Johns Hopkins University School of Medicine, the senior author of the study. That can only be accomplished by curing latent TB, he said.
Latent TB refers to infection by the TB bacterium in people who do not have symptoms and cannot infect others. But that latent infection can be converted into an active one by many different factors — at which point the patient becomes infectious.
Although TB control measures in the United States have brought the incidence of the disease to an all-time low of 11,181 cases in 2010, it is estimated that at least 11 million Americans have latent TB.
"The 11 million Americans with latent TB represent a ticking time bomb," Dr. Kenneth Castro, director of the Centers for Disease Control and Prevention's division of tuberculosis elimination, said at a news conference Monday. "They're the source of future TB cases."
Daily doses of the antibiotic isoniazid have been the standard of care for TB for nearly 60 years. But a newer, more potent drug, rifapentine, marketed under the brand name Priftin by Sanofi-Aventis, persists in the body for long periods.
In the study, begun 10 years ago, researchers enrolled 8,053 people with latent TB, most living in the U.S. and Canada, though some were in Brazil and Spain. Half were selected to receive conventional daily isoniazid treatment for nine months and half received a combination of isoniazid and rifapentine weekly for 12 weeks.
In the 33 months of follow-up, seven of those receiving the combination therapy developed TB, compared with 15 of those receiving isoniazid alone, coauthor Dr. Timothy Sterling of Vanderbilt University reported at the American Thoracic Society International Conference in Denver.
The combination "works certainly as well as isoniazid, and actually a little bit better," Chaisson said.
One complication is that the treatment cannot be given simultaneously with drugs for HIV infections, a significant drawback because many patients in the developing world have both diseases. Rifapentine stimulates the production of liver enzymes that break down many drugs, including protease inhibitors used for HIV treatment. The enzymes reduce levels of the drugs by as much as 95%, making use of the drugs at the same time pointless.
Chaisson said the team was now testing a regimen in which protease inhibitor treatment is halted for a month and rifapentine given daily. Normal HIV treatment is then resumed. Results from that study should be published soon.
The trial was sponsored by the CDC, and results have been submitted for publication.
http://www.latimes.com/health/la-he-latent-tb-20110517,0,2486639.story
Wednesday, 13 April 2011
TUBERCULOSIS: Genetic variation of Mycobacterium tuberculosis circulating in Kharkiv Oblast, Ukraine.
Maya A Dymova , Oleksandr A Liashenko , Petro I Poteiko , Valeriy S Krutko , Evgenyi A Khrapov and Maxim L Filipenko BMC Infectious Diseases 2011, 11: 28 March 2011
Background
A persistent increase of tuberculosis cases has recently been noted in the Ukraine. The reported incidence of drug-resistant isolates of M. tuberculosis is growing steadily; however, data on the genetic variation of isolates of M. tuberculosis circulating in northern Ukraine and on the spectrum and frequency of occurrence of mutations determining resistance to the principal anti-tuberculosis drugs isoniazid and rifampicin have not yet been reported.
Methods
Isolates of M. tuberculosis from 98 tuberculosis patients living in Kharkov Region (Ukraine) were analyzed using VNTR- and RFLP-IS6110-typing methods. Mutations associated with resistance to rifampicin and isoniazid were detected by RFLP-PCR methods, and also confirmed by sequencing.
Results
We identified 75 different genetic profiles. Thirty four (34%) isolates belonged to the Beijing genotype and 23 (23%) isolates belonged to the LAM families. A cluster of isolates belonging to the LAM family had significant genetic heterogeneity, indicating that this family had an ancient distribution and circulation in this geographical region. Moreover, we found a significant percentage of the isolates (36%) belonged to as yet unidentified families of M. tuberculosis or had individual non-clustering genotypes. Mutations conferring rifampicin and isoniazid resistance were detected in 49% and 54% isolates, respectively. Mutations in codon 531 of the rpoB gene and codon 315 of the katG gene were predominant among drug-resisitant isolates. An association was found for belonging to the LAM strain family and having multiple drug resistance (R = 0.27, p = 0.0059) and also for the presence of a mutation in codon 531 of the rpoB gene and belonging to the Beijing strain family (R = 0.2, p = 0.04).
Conclusions
Transmission of drug-resistant isolates seems to contribute to the spread of resistant TB in this oblast. The Beijing genotype and LAM genotype should be seen as a major cause of drug -resistance TB in this region.
http://www.biomedcentral.com/1471-2334/11/77
Background
A persistent increase of tuberculosis cases has recently been noted in the Ukraine. The reported incidence of drug-resistant isolates of M. tuberculosis is growing steadily; however, data on the genetic variation of isolates of M. tuberculosis circulating in northern Ukraine and on the spectrum and frequency of occurrence of mutations determining resistance to the principal anti-tuberculosis drugs isoniazid and rifampicin have not yet been reported.
Methods
Isolates of M. tuberculosis from 98 tuberculosis patients living in Kharkov Region (Ukraine) were analyzed using VNTR- and RFLP-IS6110-typing methods. Mutations associated with resistance to rifampicin and isoniazid were detected by RFLP-PCR methods, and also confirmed by sequencing.
Results
We identified 75 different genetic profiles. Thirty four (34%) isolates belonged to the Beijing genotype and 23 (23%) isolates belonged to the LAM families. A cluster of isolates belonging to the LAM family had significant genetic heterogeneity, indicating that this family had an ancient distribution and circulation in this geographical region. Moreover, we found a significant percentage of the isolates (36%) belonged to as yet unidentified families of M. tuberculosis or had individual non-clustering genotypes. Mutations conferring rifampicin and isoniazid resistance were detected in 49% and 54% isolates, respectively. Mutations in codon 531 of the rpoB gene and codon 315 of the katG gene were predominant among drug-resisitant isolates. An association was found for belonging to the LAM strain family and having multiple drug resistance (R = 0.27, p = 0.0059) and also for the presence of a mutation in codon 531 of the rpoB gene and belonging to the Beijing strain family (R = 0.2, p = 0.04).
Conclusions
Transmission of drug-resistant isolates seems to contribute to the spread of resistant TB in this oblast. The Beijing genotype and LAM genotype should be seen as a major cause of drug -resistance TB in this region.
http://www.biomedcentral.com/1471-2334/11/77
Monday, 10 January 2011
TUBERCULOSIS: Treatment of paediatric TB: revised WHO guidelines
Stephen M. Graham
The World Health Organization has recently revised the recommended dosages of the main first-line anti-tuberculosis drugs for use in children. The recommended dosages and range of isoniazid, rifampicin, pyrazinamide and ethambutol have been increased from the previous recommended dosages. Ethambutol is now recommended for use in children of all ages including those of less than 5 years of age. This review explains the rationale for these recent revisions. Children require higher dosages than adults to achieve the same serum concentrations. Available data in HIV-uninfected children suggest that the revised dosages are within limits that have a very low risk of toxicity. An important challenge will be to examine the impact of higher dosages on clinical response, drug-drug interactions and risk of toxicity in HIV-infected children.
http://www.prrjournal.com/article/PIIS1526054210000734/abstract?rss=yes
The World Health Organization has recently revised the recommended dosages of the main first-line anti-tuberculosis drugs for use in children. The recommended dosages and range of isoniazid, rifampicin, pyrazinamide and ethambutol have been increased from the previous recommended dosages. Ethambutol is now recommended for use in children of all ages including those of less than 5 years of age. This review explains the rationale for these recent revisions. Children require higher dosages than adults to achieve the same serum concentrations. Available data in HIV-uninfected children suggest that the revised dosages are within limits that have a very low risk of toxicity. An important challenge will be to examine the impact of higher dosages on clinical response, drug-drug interactions and risk of toxicity in HIV-infected children.
http://www.prrjournal.com/article/PIIS1526054210000734/abstract?rss=yes
Sunday, 9 January 2011
TUBERCULOSIS: Drug firm Lupin has signed an agreement with Brazil to supply its four-in-one combination drug to treat tuberculosis.
The Mumbai-based firm said it has signed an pact with the Department of Health, Government of Brazil and Farmanguinhos, the largest public sector undertaking in health care in Brazil, to supply the drug. “Lupin will supply the product for the next five years and also provide Farmanguinhos with the desired support for the set up of its local manufacturing in future,” it added.
The four in one combination drug is a combination of Rifampicin, Isoniazide, Ethambutol and Pyrazinamide reduces the pill burden on the patients drastically, it said.
As per the agreement, Farmanguinhos has committed to produce and supply the four-in-one combination drug to the Department of Health (Brazil), which will result in substantial savings for the government.
“We believe that this agreement is a very important proactive step in providing comprehensive therapeutic care in the areas of conventional TB and MDR-TB, which are pandemic in nature”, Lupin AAMLA (Asia, Africa, Middle East & Latin America) & Business Development President Vinod Dhawan said.
“We feel that Lupin and Farmanguinhos together as partners are best suited to address this disease area in Brazil”, he added.
Commenting on the agreement Farmanguinhos Institute of Technology director Hayne Felipe said: “This agreement is special because it provides a solution for an illness of epidemological proportion and importance.”As per the World Health Organisation, the treatment abandonment rate has fallen from eight per cent to five per cent due to the combination drug, it said.
http://www.thehindu.com/business/companies/article1034841.ece
The four in one combination drug is a combination of Rifampicin, Isoniazide, Ethambutol and Pyrazinamide reduces the pill burden on the patients drastically, it said.
As per the agreement, Farmanguinhos has committed to produce and supply the four-in-one combination drug to the Department of Health (Brazil), which will result in substantial savings for the government.
“We believe that this agreement is a very important proactive step in providing comprehensive therapeutic care in the areas of conventional TB and MDR-TB, which are pandemic in nature”, Lupin AAMLA (Asia, Africa, Middle East & Latin America) & Business Development President Vinod Dhawan said.
“We feel that Lupin and Farmanguinhos together as partners are best suited to address this disease area in Brazil”, he added.
Commenting on the agreement Farmanguinhos Institute of Technology director Hayne Felipe said: “This agreement is special because it provides a solution for an illness of epidemological proportion and importance.”As per the World Health Organisation, the treatment abandonment rate has fallen from eight per cent to five per cent due to the combination drug, it said.
http://www.thehindu.com/business/companies/article1034841.ece
Saturday, 18 December 2010
TUBERCULOSIS: Extensive transmission of an isoniazid-resistant strain of Mycobacterium tuberculosis in Sweden (2003-5).
Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden. boris.kan@karolinska.se
SETTING: City of Stockholm, Sweden.
BACKGROUND: The incidence of tuberculosis (TB) in Sweden increased by 40% between 2003 and 2005. The spread of a unique TB strain resistant to isoniazid (INH) contributed to this increase.
OBJECTIVE: To describe outbreaks of TB caused by this single strain, elucidate possible causes for its extensive spread and identify shortcomings of the TB control programme in Sweden.
RESULTS: We identified a cluster consisting of 102 culture-confirmed TB cases with identical DNA fingerprints and 26 epidemiologically related cases, not confirmed by culture, all diagnosed between 1996 and 2005. Five partly separate outbreaks of this strain were discovered. Epidemiological links were established for 56% of the culture-confirmed cases and for all cases not confirmed by culture. Three patients died while receiving treatment, four became failures and eight defaulted or were lost to follow-up. Only eight patients received directly observed treatment (DOT) up to a period of 3 months, although 40% had poor adherence.
CONCLUSIONS: Shortcomings of the national TB programme were revealed. Improved contact tracing and case holding, including DOT, is crucial to reduce TB transmission in Sweden.
http://www.ncbi.nlm.nih.gov/pubmed/18230254
SETTING: City of Stockholm, Sweden.
BACKGROUND: The incidence of tuberculosis (TB) in Sweden increased by 40% between 2003 and 2005. The spread of a unique TB strain resistant to isoniazid (INH) contributed to this increase.
OBJECTIVE: To describe outbreaks of TB caused by this single strain, elucidate possible causes for its extensive spread and identify shortcomings of the TB control programme in Sweden.
RESULTS: We identified a cluster consisting of 102 culture-confirmed TB cases with identical DNA fingerprints and 26 epidemiologically related cases, not confirmed by culture, all diagnosed between 1996 and 2005. Five partly separate outbreaks of this strain were discovered. Epidemiological links were established for 56% of the culture-confirmed cases and for all cases not confirmed by culture. Three patients died while receiving treatment, four became failures and eight defaulted or were lost to follow-up. Only eight patients received directly observed treatment (DOT) up to a period of 3 months, although 40% had poor adherence.
CONCLUSIONS: Shortcomings of the national TB programme were revealed. Improved contact tracing and case holding, including DOT, is crucial to reduce TB transmission in Sweden.
http://www.ncbi.nlm.nih.gov/pubmed/18230254
TUBERCULOSIS: Molecular epidemiology of drug-resistant tuberculosis in Sweden
Drug-resistant tuberculosis (TB), including the more severe forms of multidrug- and extensively drug-resistant forms, is an increasing public health concern globally. In Sweden the majority of patients with TB are immigrants from countries with a high incidence of TB including the drug-resistant forms. In this study, the spread of resistant TB in Sweden was investigated by molecular fingerprinting. Isolates resistant to at least one of the drugs, isoniazid, rifampicin, ethambutol or streptomycin, from 400 patients collected between 1994 and 2005, were studied by restriction fragment length polymorphism (RFLP) and by spoligotyping. Thirty-five clusters of patients infected with strains with identical RFLP and spoligotyping patterns (2–96 patients per cluster), comprising a total of 203 patients, were found. One large outbreak of isoniazid resistant tuberculosis was identified, involving 96 patients, mainly from the Horn of Africa. To identify chains of transmission, molecular epidemiological characterization of TB isolates should, if possible, be performed on isolates from all new TB patients.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VPN-4S5FJJT-3&_user=10&_coverDate=05%2F31%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1583107264&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ca52446010330645997a02e31030ab10&searchtype=a
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VPN-4S5FJJT-3&_user=10&_coverDate=05%2F31%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1583107264&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ca52446010330645997a02e31030ab10&searchtype=a
Thursday, 3 June 2010
TUBERCULOSIS: Paediatric cases difficult to diagnose
DURBAN, 2 June 2010 (PLUSNEWS) - The fight against tuberculosis (TB) has failed children: the share of paediatric TB is increasing, and children have not escaped the rising tide of drug-resistant strains, according to new research presented at the South African TB Conference. Dr Ntombi Mhlongo-Sigwebela, TB programme director at the University Research Company, a public health consultancy, told the conference in the port city of Durban that TB in children under four years of age now accounted for about nine percent of all national TB cases annually. Dr Kalpesh Rahevar, a World Health Organization (WHO) medical officer, said inconclusive conventional TB skin tests (to determine whether a patient has a latent TB infection) and the inability to get sputum samples from young children made paediatric TB more difficult to diagnose and treat than in adults. "This highlights the challenge of diagnosing children, especially at the primary care level ... there are differing abilities to accurately diagnose TB; where there is a paediatrician who takes an interest in TB, you see a higher number of cases diagnosed," Mhlongo-Sigwebela told IRIN/PlusNews. To make things worse, paediatric drug formulations and international treatment guidance for children were also inadequate, said Dr Ben Marais of University of Stellenbosch, in Western Cape Province. "The WHO only produced guidelines this year on optimal isoniazid [a drug used to treat TB] dosing for children," he told IRIN/PlusNews. "I think this speaks to how poorly we've served children ... [it has been] more than 60 years since the discovery of the drugs [and only now do] we have an optimal [paediatric] dosing." WHO has listed South Africa's TB epidemic among the world's worst, and research has indicated that about 70 percent of adult TB patients are co-infected with HIV [http://www.aidsmap.com/en/news/BEF8C8CE-BC45-4DD4-B859-00E42D5F9459.asp]. Marais said the key to preventing paediatric TB infections was halting adult TB, improving infection control, and access to isoniazid preventive TB therapy.
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