Drug-resistant tuberculosis is a "particular problem" in areas of Eastern Europe and China, according to a report released on Tuesday by the Global Project on Anti-Tuberculosis Drug Resistance Surveillance -- a joint project between the World Health Organization and the International Union Against Tuberculosis and Lung Disease -- the AP/Miami Herald reports. Researchers examined data from 67,657 TB patients in 77 countries and regions and found that the prevalence of TB strains resistant to two or more drugs was "exceptionally high in almost all former Soviet Union countries surveyed, including Estonia, Kazakhstan, Latvia, Lithuania, the Russian Federation, and Uzbekistan," according to the AP/Herald. The report said that high prevalence of multi-drug-resistant TB also was found in China's Henan and Liaoning provinces, Ecuador and Israel. In addition, the report noted that Central Europe and Africa had the lowest median levels of MDR-TB (Barr, AP/Miami Herald, 3/15). For example, only 1.6% of TB cases in South Africa are drug resistant, Abigail Wright, a co-author of the report, said, according to the New York Times. However, that percentage translates into 6,000 cases in South Africa, which has a high overall TB prevalence. TB is "common" in very poor countries that have a high HIV/AIDS prevalence because the weakened immune systems of AIDS patients makes it easier for the TB bacteria to grow, the Times reports. However, MDR-TB is more common in moderately poor countries where patients receive "inadequate" treatment, according to the Times (McNeil, New York Times, 3/16).

Treatment, Costs
Treating TB is "cheap and effective" with a six-month course of drugs that costs approximately $10, but MDR-TB treatment costs "a hundred times more," according to the Wall Street Journal. About 80% of MDR-TB cases are considered "super strain[s]" and can resist at least three of the four primary medications used to treat and cure TB, the Journal reports (Naik, Wall Street Journal, 3/16). According to WHO recommendations, TB patients should receive a combination of four first-line drugs: streptomycin, isoniazid, rifampicin and ethambutol. The standard therapy, "directly observed treatment, short course," or DOTS, requires that a family member, health care worker or traditional healer observe a patient "swallow ... each pill ... every day for six months" to help prevent drug resistance caused by a patient skipping a dose, the Times reports. The report said that Cuba, Switzerland, Britain and the United States seem to be "doing the best at treating difficult TB cases" because those countries reported significant decreases in drug resistance among TB patients who were previously treated, according to the Times. The report also noted a need for new tuberculosis drugs to be developed, Gwynne Oosterbaan, spokesperson for the Global Alliance for TB Drug Development, said, adding, "The last new drug was introduced in 1963" (New York Times, 3/16). Dr. Mario Raviglione, director of WHO's Stop TB initiative, said, "It is in the interest of every country to support rapid scale-up of TB control if we are to overcome MDR-TB. Passport control will not halt drug resistance; investment in global TB prevention will" (AP/Miami Herald, 3/15).

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