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UK and U.S. Face Increased Risk from Antibiotic-Resistant Tuberculosis

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Medical experts and health officials on both sides of the Atlantic are troubled by the emergence and spread of various strains of antibiotic-resistant tuberculosis (TB).

In the UK, the Health Protection Agency (HPA) is currently battling a potentially fatal strain of TB known as isoniazid-resistant TB which first appeared in north London in 2000. Since that time, some 200 cases of the disease have been reported throughout the UK, although London, with 188, is the real “hot spot.”

According to the HPA, “the failure of patients to complete courses of prescribed antibiotics” has facilitated the spread of isoniazid-resistant TB. Since the treatment regimen lasts six months or more, proper treatment of at-risk groups like the homeless and intravenous drug users is quite problematic thereby increasing the likelihood that the strain will continue spreading.

Incentives and other programs that encourage and reward those who adhere to the lengthy treatment routine are being utilized. These include giving out food vouchers, social service support, and accommodation assistance.

Between 1987 and 2003, London has seen TB cases double to 2,745 thereby accounting for 45%   
of all cases in England and Wales. Sir William Stewart, Chairman of the HPA, states: “The bugs are cleverer than we are. They grow, multiply and mutate more quickly than we can deal with them.

Antibiotics, though still hugely important, are no longer the saviors that they were thought to be in the 1950s.” The overuse by the medical and veterinary professions has contributed to the appearance and spread of new strains of antibiotic-resistant bacteria in hospitals and beyond.

Thus, the problem has become a global one with respect to a number of bacteria in general and TB in particular. In the U.S., for example, the groups that were once at greatest risk of developing multi-drug resistant tuberculosis (TB) included HIV patients, prisoners, and the homeless.

Today, however, it is more likely that new cases of the resistant form of the potentially deadly disease will be brought into the country by immigrants who have traveled from areas where there is a “raging pandemic” of TB.

As pointed out above, drug-resistant TB arises when ineffective drugs are prescribed or infected patients stop taking their medication too soon thereby allowing mutant strains of the TB bacteria to multiply.

Once this type of mutant strain arises it is capable of person-to-person transmission. Whereas multidrug-resistant TB had been resistant to 2 or 3 drugs in the past, today’s strains are resistant to 6 to 11 drugs.
A report in the June 8 issue of the Journal of the American Medical Association (JAMA) also reveals that California has the largest concentration of drug-resistant TB cases in the U.S. with 37 in 2004. California has gone from about 20% of the nations total cases in 2001 to an estimated 33% at present.

According to the JAMA report by Dr. Reuben Granich of the Centers for Disease Control and Prevention (CDC), most of California’s multidrug-resistant cases of TB involve people born outside of the United States.

Dr. Granich believes that the key to controlling the problem lies in caring for immigrants and enhancing TB care overseas and not in closing the borders.

Although the overall number of cases of multidrug-resistant cases of TB has declined by 76% since outbreaks in 1993, California’s total number of cases has “stagnated.” The California Department of Health is concerned with the problem of imported multidrug-resistant TB since immigrants are often poor, frightened, and prone to move frequently.

The 37 California cases in 2004 cost $8.72 million in direct medical costs and contact tracing when you include the 120 people who developed latent infections from them. Normal TB cases can usually be treated in 6 months with about $2,000 of standard antibiotics.

Cases of multidrug-resistant TB can take anywhere from 18 to 36 months to treat. The cost of the often toxic, second-line drugs required can be between $28,000 and $1.2 million per patient.   

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