The current recommended treatment for TB is to give four or more antibiotics for at least six months (this treatment is called "DOTS" or Directly Observed Therapy Short Course--but few patients would agree that taking drugs for 6 months is indeed a "short" course). New TB treatments are currently being tested, and it looks like some of them might be effective when taken for shorter periods. Joshua Salomon (Harvard School of Public Health) and colleagues used a mathematical model to predict what would happen if, instead of having to give a 6-month course, TB could be cured with just a 2-month course of antibiotics.
In Salomon and colleagues' model, a 2-month course led to a quicker fall in the number of new cases of TB each year compared with a 6-month course. Patients who fail to finish a course of treatment can infect others, and it is less likely for patients to drop out of a 2-month course than a 6-month course.
The researchers applied their model to South-East Asia, a region where DOTS is being scaled up and where one-third of all new TB cases occur. They found that even if DOTS is scaled up as planned, a 2-month drug course would still reduce new TB cases and deaths much quicker than a 6-month course.
If, for example, a 2-month drug treatment were introduced by 2012, it might prevent 13% of the new cases and 19% of the TB deaths that would otherwise occur in South-East Asia between 2012 and 2030.
These benefits might be even greater if the new, shorter course treatment freed up financial and human resources to improve efforts to detect new TB cases. On the other hand, delaying its implementation until 2022 would erase three-quarters of the predicted benefits.
Like all mathematical models, this new one makes many assumptions--including the assumption that the experimental TB drugs that are currently being tested can indeed cure TB in 2 months. Nevertheless, Salomon and colleagues' work suggests that the impact of DOTS could be improved by using shorter treatment courses.
PLEASE MENTION THE OPEN-ACCESS JOURNAL PLoS MEDICINE (www.plosmedicine.org) AS THE SOURCE FOR THESE ARTICLES AND PROVIDE A LINK TO THE FREELY-AVAILABLE TEXT. THANK YOU.
All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere--to read, download, redistribute, include in databases, and otherwise use--subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.
Citation: Salomon JA, Lloyd-Smith JO, Getz WM, Resch S, Sánchez MS, et al. (2006) Prospects for advancing tuberculosis control efforts through novel therapies. PLoS Med 3(8): e273.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030273
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-08-salomon.pdf
CONTACT:
Joshua Salomon
Harvard School of Public Health
Population and International Health
Harvard University Initiative for Global Health
104 Mount Auburn Street, Third Floor
Cambridge, MA 02138 United States of America
+1-617-495-0418
+1-617-496-3227 (fax)
jsalomon@hsph.harvard.edu
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org
Journal
PLoS Medicine