The number of drug resistant cases of tuberculosis (TB) continues to rise in the UK. 431 cases were reported in 2011, up from 342 in 2010 – an increase of 26 per cent. Overall, 8,963 new cases of TB were reported to the Health protection Agency (HPA) in 2011, up from 8,410 cases in 2010. Although this represents an increase in new cases, it is within the range reported to the HPA in recent years.
Drug resistance arises due to improper use of antibiotics in chemotherapy of drug-susceptible TB patients. This improper use is a result of a number of actions including, administration of improper treatment regimens and failure to ensure that patients complete the whole course of treatment. Essentially, drug resistance is a man-made problem that arises in areas with weak TB control programmes. A patient who develops active disease with a drug-resistant TB strain can transmit this form of TB to other individuals.
Drug resistant strains of the TB are not only more difficult and costly to treat (up to £250,000 per case for the most severe forms), but they require up to two years of treatment with patients taking over 20 tablets a day as well as taking regular injections with horrible side effects.
Commenting on the announcement Professor Ibrahim Abubakar, head of TB surveillance at the HPA said:
“Although we are disappointed that there has been an increase in new TB diagnoses in the past year, we are pleased that TB cases overall have been stabilising since 2005 with around 8,500-9,000 new diagnoses each year. However, the increase in drug resistant cases remains a concern and a challenge to our efforts to control TB in the UK.”
Professor Abubakar, continued: “Failing to complete treatment is one of the key causes of drug resistance. Although we are seeing increases in both drug resistant and multi-drug resistant TB (MDR TB), it’s very encouraging that the proportion of people who are completing their treatment is increasing.
“TB continues to disproportionately affect those in hard to reach and vulnerable groups, particularly migrants. In order to reduce TB cases in the future, it’s very important that health commissioners, especially in parts of the country with the highest rates of TB, prioritise the delivery of appropriate clinical and public health TB services.
“In addition, the HPA is recommending that local commissioners ensure they coordinate their TB control activities so that completion of treatment can be ensured wherever the patient is located. The message that not completing the full course of treatment can encourage drug resistance is an important one in light of today’s figures.”
What is the scale of the problem globally?
Anti-tuberculosis (TB) drug resistance is a major public health problem that threatens progress made in TB care and control worldwide. Drug resistant strains of the disease are increasing across the world each year. In 2010 there were an estimated 650,000 cases of multi drug resistant TB (MDR TB) with only a small percentage (under 10%) of patients on treatment.
What does the WHO recommend should be done to address drug resistant TB?
The discovery of patients with MDR or extensively drug resistant (XDR) TB – one of the most extreme forms of the diseases – emphasizes the importance of ensuring that all care for tuberculosis, whether in the public or private sector, must conform to international standards in order to prevent the emergence of drug resistance. Almost all countries must, in addition, ensure appropriate diagnosis and treatment of cases of MDR-TB. National regulations for the quality and dispensing of anti-TB drugs, particularly of the second-line drugs, need to be strictly enforced.
To achieve this, most countries require simultaneous scale-up of the diagnostic and treatment services for drug-resistant TB, and the provision of adequate and continuous supplies of quality assured SLDs for both MDR- and XDR-TB to meet the increased demand.
MDR and XDR-TB raise many difficult issues concerning the management of patients, for example, whether to isolate patients, the need for institutional, palliative or end-of-life care, and the compassionate use of new drugs.
What strategies underlie WHO’s recommendations for dealing with drug resistance?
The WHO-recommended Stop TB Strategy provides the framework for the effective large-scale treatment and control of both drug-susceptible and drug-resistant disease. The Global Plan to Stop TB, 2011 – 2015, developed by the Stop TB Partnership, including WHO, estimates the required funding for implementation levels needed to achieve global targets. Critical weaknesses in many countries’ current capacity and approaches to the treatment and control of MDR-TB and XDR-TB have been identified and the policy approaches necessary to address them have been described, but unfortunately not fully implemented.
What can be done?
First and foremost it is about ensuring patients complete the full course of treatment for TB to avoid the disease becoming drug resistant. It is essential the words of Professor Abubakar are heard. Health commissioners, especially in parts of the country with the highest rates of TB, must prioritise the delivery of appropriate clinical and public health TB services.
It is also essential that we continue global efforts to control TB, as noted on the HPA website “The UK should continue to contribute to international tuberculosis control efforts and strengthen our role in addressing the wider determinants of the disease.” TB control is a strong example of how promoting development abroad has a direct benefit to Britain.