Post-2015 Consensus: Health Viewpoint - Tuberculosis, Wang and Osih
Wang and Osih question whether enough attention is being paid to the most effective use of drugs, in particular for the treatment of MDR-TB. This is difficult to treat and yet it is essential to do so if the post-2015 target for TB eradication is to be achieved. Since streptomycin was discovered in the mid-20th Century, the treatment of TB has evolved as the bacterium has itself evolved, and drug-susceptible TB is now generally treated with a four-drug regimen over six months. But the fight against TB was so successful that the world became complacent, and old drugs are being resurrected to treat MDR-TB as new ones have not been developed. The system, instead of being attuned to signals of efficacy, is attuned to signals of safety.
TB, and MDR-TB in particular, should be recognized as a public health emergency. Best practice in treatment should be disseminated urgently and a solid evidence base gathered for drugs which are promising but have not been tested to modern standards. Drugs used must not only be clinically effective, but also without severe side-effects. The side effects that MDR-TB drugs can produce in patients are so horrendous that they do often beg the question: to treat or not to treat? Also the drugs used must be affordable to the patient and society as a whole, particularly given that TB is a poor person’s disease and treatment takes a long time. Funding of TB R&D is also at an all-time low, and the funding gap must be closed.