They are being treated with two TB drugs never before used in South Africa in the hope that they won’t be resistant to these drugs and their TB can be brought under control. But it’s too early to tell whether these new drugs work.
This is according to Bruce Margo, manager of the KwaZulu-Natal provincial TB programme.
Margo adds that research shows that the outbreak of XDR TB is largely confined to patients from the Church of Scotland Hospital, rather than a province-wide problem.
Since XDR TB was identified little over a year ago at Church of Scotland, provincial laboratories have embarked on a gruelling process of re-testing all previous patients’ TB specimens to see whether they could find other XDR patients. Yet only a handful of other XDR cases have been found outside of Tugela Ferry.
In contrast, however, 55% of all cases of multi-drug resistant (MDR) TB at Church of Scotland have turned out to be XDR TB.
This has led experts to believe that the Tugela Ferry patients were probably exposed to XDR TB while being treated at the hospital itself.
According to the World Health Organisation this week, countries are not acting fast enough against XDR TB.
“We have a clear plan on how to control XDR-TB, but countries are moving far too slowly on implementing this plan,’ said Dr Mario Raviglione, Director of the WHO Stop TB Department this week.
‘Funding is an issue as well — it will take an additional US$ 650 million globally to implement control of both XDR-TB and multi-drug-resistant TB (MDR-TB) in 2007 alone,” he added.
“Beyond that, because of the threat of XDR-TB, research to identify new diagnostics, drugs and vaccines is more vital than ever.”
A WHO team is expected in South Africa next week to assist with the fight against XDR TB.
MDR TB is when a TB patient fails to improve on the two normal drugs used for TB, and has to be put onto four new drugs called second line treatment.
XDR TB patients are resistant to two of the four second line drugs.
Margo says the XDR patients are resistant to two of the drugs used to treat multi-drug resistant (MDR) TB ‘ Amikacin and Ofloxin. These two drugs are also used to treat other illnesses including sexually transmitted infections, and their over prescription for illnesses other than TB could well have reduced their efficacy as TB drugs.
‘The two new TB drugs that we are trying are Capreomycin and PAS,’ says Margo. ‘They are not new TB drugs but they have never been used in South Africa before, so patients should not be resistant to them.’
But the health department will have to wait some months to see whether the two drugs actually work.
In the meantime, says Margo, all relatives and people in close contact with the XDR patients at Church of Scotland have been traced and tested.
‘At first, 12 families absolutely refused to have anything to do with us. Because of the mass hysteria in the media, they were afraid that they would be persecuted. But they have since been persuaded to be tested.’
Margo admits that drug resistant TB is the result of a failed TB treatment programme. However, the provincial health department is making a huge effort to contain those with MDR and XDR TB.
‘Until now, we have only had 240 beds for MDR TB patients in the province. The treatment centres have been too far from people’s homes and they have left hospital without being cured,’ says Margo.
‘By the end of July, we are going to dramatically increase the beds to 703 beds decentralised throughout the province.’
New MDR facilities are being prepared in Durban (Friends of the Sick Association in Clairwood), Port Shepstone (Murchison Hospital), Pietermaritzburg (Doris Goodwin Centre), Greytown (M3 Hospital), Empangeni (Catherine Booth Hospital) and Thulasizwe in Zululand and Manguzi Hospital in the far north of the province. ‘ Health-e News Service.