Patients suffering from tuberculosis now have an
alternative form of treatment involving far fewer pills — currently up
to 16 a day — to cure their disease. Experts writing in the January
issue of the Bulletin of the World Health Organization say the
new treatment, which reduces the number of tablets to as few as three or
four per day, will also combat the spread of drug-resistant forms of the
deadly disease, especially in the world's worst-affected countries.
Proposed by the World Health Organization (WHO) in
the mid-1990s but not yet adopted by all countries, the new treatment
has recently become cheaper and therefore more accessible even to people
in the poorest countries.
The proposed treatment replaces individual tablets of
the different drugs with fixed-dose combination tablets (FDCs), which
contain up to four different drugs. This solution would mean hundreds
fewer tablets that each patient has to swallow over the whole course of
The authors of the Bulletin article are
members of an international team of TB experts — Dr Bjorn Blomberg, of
Bergen University, Norway, Dr Sergio Spinaci, of WHO, Geneva, Dr Bernard
Fourie, of the Medical Research Council, Pretoria, South Africa, and Dr
Richard Laing, of Boston University, USA.
"It is important that FDCs become part of
government policy in all countries, especially in the 22 TB high-burden
countries," Dr Spinaci said today. "Until recently the cost of
fixed-dose combinations was higher than the sum of the costs of the
individual single-drug tablets," he said. "But in the past
year the cost of a full course of TB treatment using FDCs has dropped to
about the same as that of individual drugs. With their increasing use,
cost is no longer an obstacle to the wider implementation of this
treatment. For the poorer countries with the highest burdens, this is
particularly good news."
Currently there are an estimated eight million new TB
cases a year and at least two million TB deaths a year worldwide. Eighty
per cent of the cases occur in 22 "high burden" countries,
mostly in Asia and Africa.
The mainstay of treating TB is with a combination of
several different medicines, given under supervision. Typically, TB
patients have to take as many as 16 pills a day for at least two months,
and then up to nine pills a day for a further four or six months, in
order to recover fully. Many patients fail to stay the course, which
denies them a cure, and favours the development and spread of drug
The authors explain that the FDCs are being
recommended by WHO and the International Union Against Tuberculosis and
Lung Disease, and are now being used in about 40 countries. They urge
tuberculosis treatment programmes in other countries to begin using the
The authors say in the Bulletin article: FDCs
simplify the prescription and supply of drugs and may also limit the risk of
drug-resistant tuberculosis arising.
"One of the constraints in the conventional
treatment is that patients have to take a large number of tablets.
Having fewer pills to swallow makes treatment easier and minimizes the
probability of splitting the doses or of taking only some of the drugs
in the regimen.
"In view of the enormous costs and difficulties
in treating drug-resistant tuberculosis, the highest priority must be
given to preventing the emergence of drug resistance in the first place.
"The most important step is to ensure adequate
treatment of all TB patients. Acquired resistance most commonly follows
erratic drug-taking, that is, interrupting treatment frequently and for
long enough to allow re-growth of bacteria which might favour resistant
"Multiple interruptions of treatment have been
shown to be the predominant cause of drug resistance."
The authors emphasize that although the use of FDCs
simplifies prescribing and drug-taking, it does not eliminate the need
for direct observation of TB treatment.
Dr Spinaci added: "The pioneering work in the
area of FDCs is a benchmark and an example of how fixed-dose
combinations could be developed for use in the treatment of other
infectious diseases such as malaria and HIV/AIDS."