It is too early to discount the contribution of isoniazid to the treatment of tuberculous meningitis.
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Antitubercular Agents↗
Biomedical subjects
Barbara J Seaworth
Publications and source records attributed to Barbara J Seaworth.
Drug-resistant tuberculosis: controversies and challenges in pediatrics.
Tuberculosis remains one of the top two causes of death caused by a single infectious disease worldwide, despite curative therapy. Children with tuberculosis are especially difficult to detect, since acid fast bacilli smears and cultures are usually negative and clinical signs are nonspecific or lacking. Multidrug-resistant tuberculosis, or tuberculosis resistant to at least isoniazid and rifampin, has emerged in most areas of the world over the past 20 years. Treatment of multidrug-resistant tuberculosis is more expensive and difficult. The second-line tuberculosis medications required for treatment are more toxic and less efficacious than standard treatment. These medications are not readily available in many areas of the world where drug resistance is most common. Fluoroquinolones are one of the most promising classes of second-line medications, but are not generally recommended for use in children. Ethambutol is recommended in the initial treatment of tuberculosis in children treated in areas where there is a risk of drug-resistant disease and the susceptibility of the source case is not known. Some experts have been hesitant to use ethambutol due to the risk of visual impairment associated with the drug and the difficulties in monitoring vision in young children. Pediatric drug formulations are not available for most antituberculosis medications, even the first-line tuberculosis drugs. Treatment of children exposed, infected or ill with multidrug-resistant tuberculosis is reviewed with special emphasis on second-line drugs, including recommended dosage, available formulations and necessary monitoring. While new cases of multidrug-resistant tuberculosis have decreased in most developed countries over the past 10 years, cases continue to increase in many developing countries and among immigrants from high-risk areas. Tuberculosis and multidrug-resistant tuberculosis are serious threats requiring worldwide strategies to control and treat. Better diagnostic tests, medications, public health strategies and vaccines will all be needed to eliminate tuberculosis.
Animals↗
Multidrug-resistant tuberculosis.
Multidrug-resistant TB is a growing public health problem. Although control of the multidrug-resistant TB epidemic has been achieved in New York City, strains of multidrug-resistant TB are found in nearly every state. Much of the world faces a growing problem with no immediate solution. The treatment habits and policies that have led to this problem persist. New drug development has been almost nonexistent. The current tremendous global interest offers hope, as does the Global Alliance for Tuberculosis Drug Development supported by the Rockefeller Foundation and the Bill and Melinda Gates Foundation. Their mission is to accelerate the discovery and development of new antituberculosis drugs and put them on the market within 10 years, at prices affordable in less-developed countries. As Dr. Reichman notes, "this action will not address the main underlying cause of almost all drug resistance, non-adherence of patients and doctors to recommended regimens." He calls for an equal commitment to improving the capacity of health care workers to use new and older agents correctly, so that they may continue to be effective in the future. Each year brings new, at-risk immigrants to the United States from all regions of the globe. They bring all the TB problems of their countries of origin with them. Foreign-born people will have a significant impact on TB control efforts in the next decade and beyond. TB elimination programs will need to incorporate systems that can adequately address TB within the United States and support national TB programs in developing countries to help them develop the capacity to successfully manage their own TB problems. A review of the drug resistance patterns isolated from foreign-born people should be adequate to convince even skeptics of the need to support global TB programs.
Humans↗
Transmission of drug-resistant tuberculosis in Texas and Mexico.
To examine the transmission of drug-resistant (DR) tuberculosis between Texas and Mexico, Mycobacterium tuberculosis isolates resistant to one or more of the first-line antimycobacterial drugs were obtained from 606 patients who resided in Texas and 313 patients who resided in Mexico, primarily within the state of Tamaulipas. The isolates were genotyped by IS6110-based restriction fragment length polymorphism (RFLP) analysis and spoligotyping. Of the 919 isolates genotyped, 413 (45%) grouped into 105 clusters containing 2 or more isolates with identical genotypes. In addition to having identical genotypes, identical drug resistance patterns were identified in 250 isolates in 78 clusters (DR clusters). Twenty DR clusters, containing isolates from 32% of the total number of patients infected with DR strains, were geographically distributed across Mexico and Texas. Within this population of 919 patients infected with DR isolates, the probability of being in a DR cluster was the same for residents of Mexico and Texas. In Texas, the significant independent predictors of clustering within DR clusters as opposed to genotype clusters were found to be race, age, country of birth, human immunodeficiency virus (HIV) infection status, and resistance to more than one drug. Specifically, isolates from African Americans, individuals under age 65, individuals born in the United States, and HIV-positive individuals were each more likely to be associated with a DR cluster. By contrast, no significant independent predictors of clustering in a DR cluster were identified in Mexico. Although some DR M. tuberculosis strains are geographically restricted, this study suggests that a number of strains are transmitted between Mexico and the United States.
Adolescent↗