A new study published in the New England Journal of Medicine reports that as many as one in ten cases of tuberculosis in China is multi-drug-resistant, with eight percent of those cases being extensively drug-resistant (XDR). One in four cases is resistant to at least one drug. Although China has a relatively low prevalence rate (108 in 100,000) and has made good strides against the disease, the country has a population of almost one and a half billion people and an estimated one million cases of TB.
The study points out that weak points in China’s health system have brought about the growth of multi-drug-resistant tuberculosis (MDR-TB). As the AP reports, patients treated at TB hospitals were at a greater risk of contracting MDR-TB, and prescribing the wrong drugs and a lack of testing is common. The MDR-TB prevalence in China is almost double the global average and makes up a quarter of all cases.
As I’ve written in the past, drug resistance is an escalating global problem as antibiotics and other drugs are mis- or over-used, while patients do not adhere fully to treatment regimens. It’s very possible that drug resistance will be our next major global health problem–one that will require breakthrough pharmaceutical discoveries on a par with penicillin. The rise of drug-resistant tuberculosis (TB) is especially concerning, and this week’s news leaves more to worry about. Without robust testing, treatment, and health systems, followed by the development of new drugs to treat drug-resistant strains, MDR-TB and ultimately XDR-TB incidences will only increase.
New approaches to TB worldwide will require coordinated, concerted efforts from a wide range of stakeholders–including governments, non-profits, and the private sector, as well as healthcare workers and patients themselves. It is surprisingly easy to skip pills or stop treatment: I’d estimate that almost everyone who’s ever had a prescription has forgotten or chosen not to take an entire course of antibiotics or other drugs. I know I certainly have. When a course of treatment is six months or more, doesn’t make you feel very well, and isn’t well-supervised by a doctor, nurse, or caseworker, the odds of a fully adherent patient drastically decrease. We’ve reached the point, however, where adherence alone won’t solve the problem–we need to develop new drugs, and we need to do it now. Recent reports like this one out of China, and earlier about totally drug-resistant cases in India, only illustrate that we’re on the edge of a much greater problem.
Header photo by the Gates Foundation, via Flickr.