

Totally drug-resistant TB emerges in India - pwg
http://www.nature.com/news/totally-drug-resistant-tb-emerges-in-india-1.9797

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mcbaby
Vaccines and antibiotics are not the only ways, and certainly not the most
effective ways, to fight bacterial infections.

What we should be focusing on is developing bacteriophage technology (namely
phage lysins).

As every human (a eukaryote) is prone to certain viruses (which can act only
on eukaryotes), every bacteria (a prokaryote), this includes strep throat, TB,
etc., is vulnerable to certain viruses (which can only work prokaryotes).
These viruses are so specific that they only work on one type of bacteria, and
they evolve at nearly the same rate as a bacteria evolves (which is how TB has
become antibiotic resistant).

<http://www.rockefeller.edu/vaf/phage.php>

~~~
carbocation
People have been trying to use mycobacteriophages to treat TB since the 90s
(at least) with no success:
[http://tbevidence.org/tbevidence_old_site_files/documents/re...](http://tbevidence.org/tbevidence_old_site_files/documents/rescentre/sop/studies/Bacteriophage-
based%20assay/General/9.pdf)

In contrast, vaccines for TB have made actual progress in animal studies:
<http://www.nature.com/nm/journal/v17/n10/full/nm.2420.html>

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boneheadmed
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...](http://en.wikipedia.org/wiki/Multi-drug-
resistant_tuberculosis)

~~~
carbocation
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...](http://cid.oxfordjournals.org/content/early/2011/11/24/cid.cir889)

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.)

~~~
dredmorbius
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>

~~~
carbocation
The TB research community must know the state of the art, but I'm having a
hard time finding it; I found some pubmed links supporting the use of
sulfonamides, but nothing really since the 1940s. Not a lot of info about why
these dropped off the map.

------
tomjen3
That 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.

~~~
hesdeadjim
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.

Both of these factors combine to create a great environment for disease
resistant strains of bacteria to emerge.

~~~
Swizec
As a person who usually doesn't finish the full course of antibiotics if
they're feeling healthy: Why does it matter?

~~~
whimsy
I don't understand why this was downvoted. This is an excellent question.

~~~
munin
good question, terrible person

~~~
gommm
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.

~~~
harshreality
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 laser with remaining good eye?" If you
don't know what a laser is or why it might be bad to look into it, you either
research the issue, or you follow those instructions blindly (pun intended).
You don't blow them off and then ask HN why looking into class 4 lasers is bad
after both your eyes are damaged.

It's good that they finally asked, though. It should have been asked a long
time ago, and not on HN, I think that's the point of the downvotes.

~~~
anon123890
> 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.

