I think that what is termed "totally drug resistant TB" is more a matter of semantics as the article points out. I was in medical training in Southern California about 8 years ago and spent some time with a large county tuberculosis surveillance unit as part of a public health assignment. There were about five cases of then termed "multi-drug resistant TB" whereby the patients were either confined to their homes or an isolation unit in a hospital. They were under mandatory confinement and observation, enforceable by law. I had no idea that such cases existed at the time. I would refer people to this wikipedia article which has good information:
http://en.wikipedia.org/wiki/Multi-drug-resistant_tuberculos...
Totally drug-resistant TB emerges in India
21–30 of 44 posts
Re: Totally drug-resistant TB emerges in India
#22I think that what is termed "totally drug resistant TB" is more a matter of semantics as the article points out. I was in medical training in Southern California about 8 years ago and spent some time with a large county tuberculosis surveillance unit as part of a public health assignment. There were about five cases of then termed "multi-drug resistant TB" whereby the patients were either confined to their homes or a…
We've still got MDR-TB. But now we have XDR-TB (extensively drug-resistant TB) and TDR-TB (totally drug-resistant TB). Each less desirable to encounter than the last. TDR-TB seems to be the real deal: http://cid.oxfordjournals.org/content/early/2011/11/24/cid.c...
It's behind a paywall, but the gist is that some of these patients had TB resistant to ALL of the following:
isoniazid, rifampicin, ethambutol, pyrazinamide, and streptomycin (1st-line agents); as well as ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid, and ethionamide (apparently 2nd-line agents).
Interestingly, the report doesn't discuss whether experimental/3rd-line treatments were tried (including my favorite from M2 year, linezolid). So it's possible that there's still something in our armamentarium that hasn't yet been tried (due, perhaps, to prohibitive cost). (And note that TB, and ID in general, is not my area of focus.)
Re: Totally drug-resistant TB emerges in India
#23Earlier quoted context omitted.
I don't understand why this was downvoted. This is an excellent question.
good question, terrible person
The negative impact of not finishing antibiotics was news to me, and now I know. I think it's ridiculous to call him a terrible person. Uninformed maybe. Although that's no longer the case.
Re: Totally drug-resistant TB emerges in India
#24Earlier quoted context omitted.
It's not quite that simple. This popped up on Reddit a few days back and in the comments a physician from India mentioned that a big part of the problem is that a) antibiotics are extremely over-used as they can be gotten over the counter and people do not understand that they do nothing for viral infections like the common cold, and b) his patients rarely finished an entire course even when they were directed to. Bo…
As a person who usually doesn't finish the full course of antibiotics if they're feeling healthy: Why does it matter?
Take this anecdote as informative, not judgmental: it is most likely (according to the journal article) that these patients developed TDR-TB because they received incomplete treatment with 2nd-line agents.
Re: Totally drug-resistant TB emerges in India
#25Earlier quoted context omitted.
Well I wouldn't say terrible person. The problem is that this is not well explained and so most people just do not understand the problems associated with not completing the antibiotic treatment prescribed by the doctor... It's good that he asked and now he will know why it's important and will do it.. It's a failure of education if intelligent and educated people are not aware of the consequences.
It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through. I wonder what other prescription instructions he disregards... drug interaction warnings? You don't get to disregard those just because you're not familiar with the biochemistry involved. Or, what about, "Do not look into 1W las…
> It doesn't have to be well explained. Instructions for antibiotic prescriptions from a licensed doctor/pharmacy tells you to take the full course of antibiotics and not quit part way through.
Why shouldn't it be well explained? It's not like it's rare for doctors to prescribe things people don't really need, especially in this day and age, in the USA.
Re: Totally drug-resistant TB emerges in India
#26Re: Totally drug-resistant TB emerges in India
#27That is to be expected when no new drugs are developed in half a century. We really should focus more on doing what we did with smallpox -- destroy it outright, rather than merely give it a bloody nose or two.
We will never, ever destroy TB. There are simply too many animal hosts for the disease. Hell, you can get it from your dog ( http://www.petplace.com/dogs/tuberculosis-in-dogs/page1.aspx ). The reason we could get rid of smallpox, the only reason, is that smallpox is a disease found only in human beings. There aren't a whole lot of diseases like this. Polio is one, I think. But most communicable diseases that afflict…
Some of those would be easier to exterminate than others. Many animals carry influenza or plague, but isn't leprosy limited to humans and armadillos?
Re: Totally drug-resistant TB emerges in India
#28Earlier quoted context omitted.
good question, terrible person
Well I wouldn't say terrible person. The problem is that this is not well explained and so most people just do not understand the problems associated with not completing the antibiotic treatment prescribed by the doctor... It's good that he asked and now he will know why it's important and will do it.. It's a failure of education if intelligent and educated people are not aware of the consequences.
In India, not many people have access to a decent education let alone access to the internet where you can freely read up on any medication that you are prescribed. Many of the doctors here are assholes who will prescribe antibiotics for even the common cold saying "most of our patients want antibiotics so we give it to them".
I wouldn't call the average person without the access to knowledge and resources that the average HN user has a terrible person for abusing antibiotics in this fashion but in my opinion, swizec should know better.
Re: Totally drug-resistant TB emerges in India
#29Earlier quoted context omitted.
We will never, ever destroy TB. There are simply too many animal hosts for the disease. Hell, you can get it from your dog ( http://www.petplace.com/dogs/tuberculosis-in-dogs/page1.aspx ). The reason we could get rid of smallpox, the only reason, is that smallpox is a disease found only in human beings. There aren't a whole lot of diseases like this. Polio is one, I think. But most communicable diseases that afflict…
Some of those would be easier to exterminate than others. Many animals carry influenza or plague, but isn't leprosy limited to humans and armadillos?
I don't know. But even if it's true, and even assuming we can develop a vaccine, how do you propose to go out and vaccinate every nine-banded armadillo, not missing even one population large enough to harbor the disease? This isn't an endangered species - they're all over the southeastern US.
Re: Totally drug-resistant TB emerges in India
#30I think that what is termed "totally drug resistant TB" is more a matter of semantics as the article points out. I was in medical training in Southern California about 8 years ago and spent some time with a large county tuberculosis surveillance unit as part of a public health assignment. There were about five cases of then termed "multi-drug resistant TB" whereby the patients were either confined to their homes or a…
We've still got MDR-TB. But now we have XDR-TB (extensively drug-resistant TB) and TDR-TB (totally drug-resistant TB). Each less desirable to encounter than the last. TDR-TB seems to be the real deal: http://cid.oxfordjournals.org/content/early/2011/11/24/cid.c... It's behind a paywall, but the gist is that some of these patients had TB resistant to ALL of the following: isoniazid, rifampicin, ethambutol, pyrazinamid…
I'm not up on my medical compounds, but how do the resistant strains respond to pre-penicillin compounds such as sulfa drugs and the like. Solfonamide: http://en.wikipedia.org/wiki/Sulfonamide_(medicine)
I've read, years ago, some speculation that these might be used to help beat down if not extinguish, an infection.
Seems that there was some work in this regards in the 1940s, but I don't see much since: http://chestjournal.chestpubs.org/content/8/6/166.abstract