The challenge of the new tuberculosis drugs
Simon Tiberi
1,9
, Ruaridh Buchanan
1,9
, José A. Caminero
2,3
, Rosella Centis
4
, Marcos Abdo Arbex
5
,
Miguel Salazar
6
, Jessica Potter
7,8
, Giovanni Battista Migliori
4
1. Barts Health NHS Trust, Royal London Hospital, Division of Infection, 80 Newark
Street, E1 2ES London, United Kingdom
2. University Hospital of Gran Canaria "Dr Negrin'', Pneumology Department,
Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain
3. International Union against Tuberculosis and Lung Disease, Paris, France
4. Maugeri Care and Research Institute, IRCCS, World Health Organization
Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy
5. University Center of Araraquara Hospital Nestor Goulart Reis, São Paulo State
Secretary of Health, São Paulo, Brazil
6. Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER),
Mexico City, Mexico
7. Barts Health NHS Trust, Royal London Hospital, Department of Respiratory
Medicine, 80, Newark Street, E1 2ES London, United Kingdom
8. Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre
for Primary Care and Public Health, E1 2AB London, United Kingdom
Correspondance :
Giovanni Battista Migliori, Maugeri Care and Research Institute, IRCCS, World Health
Organization Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy.
giovannibattista.migliori@icsmaugeri.it
Summary
Tuberculosis (TB) continues to cause more deaths worldwide than any other single infectious
disease. Even though tuberculosis appears to be decreasing in incidence globally for some time, the
proportion of drug resistance is increasing, contributing to greater complexity, morbidity and
mortality as well as cost. Since the advent of rifampicin in the 1960s, and the implementation of
standard quadruple anti-tuberculosis regimen in the late 1970s, no new drugs have been changed
the first line regimen. This regimen is effective however it is pill burden, and duration has not
received investment and innovation. Drug-resistant regimens are long and frequently poorly
tolerated due to significant toxicity. This review is an update on what is new in the treatment
of drug-susceptible and drug-resistant tuberculosis, new TB drugs currently being used and studied
in clinical trials are also mentioned. Fortunately, there have been many significant advances in this
field in recent years. The horizon is changing with the new WHO shorter multidrug-resistant
tuberculosis regimens and with the increasing availability of new or repurposed drugs like
bedaquiline, delamanid, clofazimine and linezolid. These drugs pose new challenges relating
to their rational use to prevent selection of resistant strains of Mycobacterium tuberculosis even
before a new regimen has been studied. The availability of these new drugs is offering hope and
new possibilities for saving patients who had few or no treatment options. Their use and
combination into effective regimens need to be studied; trials are in progress. It is hoped that
soon we will be able to treat sensitive and drug-resistant cases with a universal regimen, this
would revolutionise treatment and take us another step closer towards elimination.
Disponible sur internet le :
28 février 2017
9
Tiberi and Buchanan only contributed equally.
In this issue
Editorial
Breaking the barriers:
Migrants and tuberculosis.
G. Sotgiu (Italy) et al.
Tuberculosis elimination and
the challenge of latent
tuberculosis.
A. Matteelli (Italy) et al.
The cursed duet today:
Tuberculosis and HIV-
coinfection.
S. Tiberi (UK) et al.
The challenge of the new
tuberculosis drugs.
S. Tiberi (UK) et al.
Agents of change: The role
of healthcare workers in the
prevention of nosocomial
and occupational
tuberculosis.
R. R. Nathavitharana (USA)
et al.
tome 46 > n82 > mars 2017
http://dx.doi.org/10.1016/j.lpm.2017.01.016
© 2017 Elsevier Masson SAS. Tous droits réservés.
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