It is necessary to control more the way in which these drugs are prescribed and administered, under penalty of seeing “their effectiveness canceled quickly”, warns the report, published by The Lancet Respiratory Medicine.
New treatments for resistant forms of tuberculosis could in turn become ineffective if misused, warns a report released Thursday, on the eve of World Tuberculosis Day.
In recent years, three antibiotics have appeared to treat tuberculosis: bedaquiline (marketed under the brand Sirturo by Janssen laboratories), delamanid (Deltyba, from the Otsuka laboratory) and linezolid (Zyvoxid, from Pfizer, and generics).
This is good news, because the arsenal available to fight this disease is under strain, as the bacteria responsible for tuberculosis develop new resistance. Especially since since the 1970s and the appearance of rifampicin, no new molecule had been put on the market.
According to preliminary studies, the new drugs “significantly improve the effectiveness of treatments and give hope to patients who would previously have been considered incurable”, welcomes the report.
“However, without significant investments in access to new treatments, especially shorter treatments with fewer side effects, effective drugs will become scarce again, as resistance to the latest treatments emerges,” he warns. .
Tuberculosis, a pathology caused by bacteria that mainly attacks the lungs, is the most deadly contagious disease, with 1.8 million victims in 2015 and 10.4 million people affected, 60% of whom live in six countries: India, Indonesia, China, Nigeria, Pakistan and South Africa.
20% of these cases were resistant to at least one antibiotic and 5% were multi-resistant, or 480,000 cases. Half have been identified in India, China and Russia, but migration and the development of tourism mean that “highly resistant strains of tuberculosis are present almost everywhere in the world”, underlines the report.
This resistance develops when the drug fails to kill the target bacteria, because it is not the right molecule, the wrong dose, or because the treatment is not being followed correctly. But resistant strains can also be transmitted directly from person to person.
However, multidrug-resistant forms of tuberculosis take much longer and more expensive to treat: while they represented only 5% of cases in 2015, they mobilized around a third of the resources available to fight the disease.
The problem is growing in Eastern Europe, Russia and Kazakhstan, where thousands of migrant workers arrive each year, especially from Central Asia, sometimes carriers of undiagnosed or untreated tuberculosis, underlines Michel Kazatchkine, United Nations Special Envoy for HIV / AIDS in Eastern Europe and Central Asia, who also takes a keen interest in tuberculosis, the leading killer of people with HIV.
To stop the spread of the disease, countries must stop deporting sick migrants, a practice “ineffective in terms of public health” and which can promote “types of infection resistant to treatment,” he said. .
David Moore, an infectious disease specialist at the London School of Hygiene and Tropical Medicine, insists on the need to test all patients who are diagnosed with tuberculosis to see if it is a resistant form or not.
He brushes aside the argument of too high a cost for such a generalization of testing: “The truth is, you can’t afford not to do it.”