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Contact: Sarah Clark
press@plos.org
Public Library of Science

Why is long-term therapy required to cure tuberculosis?

Understanding why other bacteria become resistant to antibiotics could hold the key to understanding why TB takes so long to cure, say researchers in a policy paper in PLoS Medicine.

Patients with TB typically have to take 4 antibiotics for 2 months and then continue 2 of these antibiotics for an additional 4 months. Why is such long treatment needed?

Lalita Ramakrishnan (University of Washington) and colleagues say that traditionally the answer was thought to lie in the fact that the tuberculosis microbe achieves a TB-specific "dormant" or non-replicating state in an infected person. Because virtually all types of antibiotics act only on replicating bacteria, the dormant state of TB is thought to render it resistant to treatment.

But the authors now challenge this traditional view. In the light of data on treating human TB and other bacterial infections, they suggest that the non-replicating state is not TB-specific and that the number of non-replicating bacteria correlates with total bacterial burden rather than TB-specific pathology.

"This correlation between bacterial burden and time to cure is not unique to TB, as it has been found in other bacterial infections, both acute and chronic," they say.

Understanding and countering the ways in which bacteria in general (rather than TB specifically) become resistant to antibiotics, say Ramakrishnan and colleagues, "may hold the key to reducing the duration of treatment of all recalcitrant bacterial infections, including TB."

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Everything published by PLoS Medicine is Open Access: freely available for anyone to read, download, redistribute and otherwise use, as long as the authorship is properly attributed.

Citation: Connolly LE, Edelstein PH, Ramakrishnan L (2007) Why is long-term therapy required to cure tuberculosis? PLoS Med 4(3): e120.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE
VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040120

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-03-ramakrishnan.pdf

Related image for press use: http://www.plos.org/press/plme-04-03-ramakrishnan-image.pdf
Caption: Global tuberculosis mortality by region, 2004 Estimated 1.7 million deaths worldwide. Data from the WHO, figure by Lynn E. Connolly

CONTACT:
Lalita Ramakrishnan
University of Washington
Microbiology, Immunology and Medicine (Allergy and ifectious diseases)
Departments of Microbiology and Medicine University of Washington Health Sciences Building, Box 357242
1959 NE Pacific Street
Seattle, WA 98195-7242
United States of America
+1 206 616-4286 (office)
+1 206 616-1575 (fax)
lalitar@u.washington.edu



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