- The authoritative medical publication, "The Lancet's
Infectious diseases magazine" has just published an article in which
top XDR- TB-experts strongly urge that drug-resistant-tuberculosis patients
be treated in seperation from all other "susceptible individuals"
in the same health-care facilities because they remain highly infectious.
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- These experts also noted that the co-infected TB+HIV
patients in South Africa are only given two drugs due to the government's
policies -- and that this poor-medication practice 'increases their drug-resistance."
The article urges the SA government to most urgently provide more second-line
TB drugs to such patients to 'avert this drug-resistance-problem."
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- "The Lancet"'s article emphasises the scientific
findings of doctors in the field in South Africa that "poor prescribing
practices" are an emerging problem of extensively drug-resistant
(XDR) tuberculosis:
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- link to entire original research document:
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- http://www.thelancet.com/journals/laninf/article/ PIIS1473309906706041/fulltext
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- This article notes that 'although improved tuberculosis
medication handling is essential, the largest study to date of XDR tuberculosis
(in South Africa's present epidemic) shows that those infected with the
disease were never exposed to second-line (tuberculosis) drugs and most
had never been treated for tuberculosis." Source link for above paragraph:
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- http://www.thelancet.com/journals/lancet/article/ PIIS0140673606695731/fulltext
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- "At least in this locale, XDR tuberculosis is not
simply a problem of acquired drug resistance," the magazine article
warns."Rather, afflicted patients were severely immunocompromised
as a result of HIV infection (with a median CD4 count of 63 cells per
mL) and were infected with XDR tuberculosis via primary transmission,
perhaps in a nosocomial setting". (In other words these patients
were infected as a result of treatment in a hospital-like setting).
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- source links for above paragraph: "Médecins
Sans Frontières. Difficulties in procurement of second-line anti-tuberculosis
drugs, May 22 2007:
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- http://www.msf.fr/documents/base/2005-10-20-MSF.pdf
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- http://en.wikipedia.org/wiki/Nosocomial_infection
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- The Lancet writes:
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- "Therefore, to promote proper standards of tuberculosis
care, those concerned about drug resistance should emphasise appropriate
treatment for HIV and the separation of drug-resistant tuberculosis patients
from susceptible individuals. "Interventions against XDR tuberculosis
should also consider drug misuse, but in the sense that limited availability
should be regarded as a form of such misuse.
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- "South African XDR-TB patients moreover, are also
showing increased drug-resistance because these patients are only given
two active agents due to 'poor medication access', according to personal
statements to The Lancet which were made by doctors at the Church of
Scotland Hospital in KwaZulu-Natal, and health-care workers at the Philanjalo
HIV-Aids organisation (which treats patients in their homes). All these
field-care health workers are warning in this article that "this
(lack of medication access) will undoubtedly amplify drugs resistance".
The Lancet comments that this (growing drug-resistance) "may be averted
by accelerating access to second-line agents (drugs) for use in bolstered
regimens."
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- source links for above paragraph:
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- http://www.msf.fr/documents/base/2005-10-20-MSF.pdf
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- http://www.investinginourfuture.org/southafrica/hiv1/
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- "Therefore, to truly control a problem such as XDR
tuberculosis, careful examination of the available data and current state
of treatment efforts in the affected regions is required, rather than
assuming that all drug resistance problems can be easily generalised."
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- http://www.thelancet.com/journals/laninf/article/ PIIS1473309907701421/fulltext?
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