By Ranjit Devraj
NEW DELHI, Aug 14 2002 (IPS)

Indian scientists have come up with a short regimen against tuberculosis (TB) that halves the six months needed under the directly observed treatment short course or DOTS, approved by the World Health Organisation (WHO).

Because it is shorter, the new regimen developed at the Tuberculosis Research Centre (TRC) in southern Chennai city, reduces the morbidity and poor compliance associated with DOTS, which relies on the closely supervised administration of a cocktail of four cheap but powerful drugs.

‘’Shorter TB treatment regimens would ease drug administration for both patients and providers,” said Shaheed Jawahar, a member of the team at the TRC that developed the new regimen.

Results of the TRC research, released in May, has since been described as ôvery promising” by an expert at the WHO’s South East Asia Regional Office (SEARO) here. ‘’If the evidence is confirmed, implications to programmes could be major,” he said.

To shorten the treatment regimen, the TRC team simply replaced one of the four drugs in the cocktail, ethambutol, with a more powerful drug oflaxacin.

While ethambutol simply weakens the tuberculosis bacteria, its replacement kills them ¡ which is proving crucial. The researchers retained the other three DOTS drugs.

A TRC study on 416 fresh cases in Chennai and Madurai, also in south India, showed that an ultra-short three-month regimen with Ofloxacin cured 99 percent patients of , with an 8 percent relapse rate.

ôA relapse rate of 8 percent is considered highly acceptable as usually, relapse rates of 20 percent are reported,” said TRC scientist M Shaheed Jawahar.

Since the 1990s, DOTS has been the cornerstone of a fight against an ancient disease that seems to have suddenly gained resurgence partly due to the development of resistance by the concerned bacterium to common antibiotics.

DOTS is designed to carefully monitor each patient’s progress while being treated with a potent combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of six months or a complete certifiable cure is achieved.

Currently, more than 56 percent of what WHO’s South-east Asia region which includes India, Indonesia and Bangladesh, has access to DOTS and nearly two million patients have been treated so far with it.

Despite the proven results of this regimen, the six months needed for DOTS are too long for many poor patients to comply with and cumbersome to implement under control programmes, say TRC researchers.

Patients who do not take the full course of the treatment not only are likely to suffer relapses but they development multi-drug resistant strains of the TB bacteria called MDRTB.

Multi-drug resistance is, in fact, compounding the TB problem in many countries since it is harder and more expensive to treat. TRC estimates that multi-drug resistant TB is at least 100 times more expensive to cure than ordinary TB.

ôIn countries that are poor, multi drug resistant TB that cannot be treated with standard medicines can be a death sentence,” a TRC scientist said. ôOur result is, in fact, a shorter DOTS. We think the implications are quite significant,” he said.

The finding could have enormous implications for global management of tuberculosis, Jawahar observed.

Shortening treatment has been a long-term goal in TB research. From 18 to 24 months when TB treatment first became available in the 1950s, clinical trials in India and other parts of the world have helped to gradually shorten the duration first to 12 months, then nine months and finally six months.

India was ironically the seedbed where the idea of DOTS took root, when TRC initially demonstrated that even destitute people living in slums of Chennai (then called Madras) could be successfully treated with regular supervised course of inexpensive anti-TB drugs.

But the efficacy of DOTS was most dramatically proved in affluent cities like New York, where there has been TB resurgence possibly as an opportunistic infection associated with rising HIV prevalence.

But the disease is typically associated with poverty and malnutrition common in developing countries.

In Bangladesh in fact, some locals wryly call TB the ôking’s disease” ¡ or ‘Raja Rog’ ¡ because only kings can afford to contract it.

TB and malaria are among the major poverty-determined diseases. They in turn deepen poverty, further marginalising the poor and depriving them the opportunities for good health.

In fact, this year, WHO’s theme for World TB Day on Mar. 24 was ôStop TB, Fight Poverty”.

India alone has more than 3.5 million tuberculosis cases that account for 30 percent of the global burden of the disease. The TRC estimates that half a million Indians die from the disease every year — or more than 1,000 cases every month or one every minute.

India tops the tuberculosis burden of WHO’s South-east Asia region, which has 40 percent of the world’s 8.7 million new cases every year. The region reports three million new cases and nearly three-quarter of a million deaths each year, says the WHO.

Financial losses sustained in the region alone are estimated at six billion U.S. dollars. TB is estimated to take an annual economic toll equivalent to 12 billion U.S. dollars from the incomes of poor communities.

Excerpt:

By Ranjit Devraj
NEW DELHI, Aug 13 2002 (IPS)

Indian scientists have come up with a short regimen against tuberculosis (TB) that halves the six months needed under the directly observed treatment short course or DOTS, approved by the World Health Organisation (WHO).

Because it is shorter, the new regimen developed at the Tuberculosis Research Centre (TRC) in southern Chennai city, reduces the morbidity and poor compliance associated with DOTS, which relies on the closely supervised administration of a cocktail of four cheap but powerful drugs.

‘’Shorter TB treatment regimens would ease drug administration for both patients and providers,” said Shaheed Jawahar, a member of the team at the TRC that developed the new regimen.

Results of the TRC research, released in May, has since been described as ôvery promising” by an expert at the WHO’s South East Asia Regional Office (SEARO) here. ‘’If the evidence is confirmed, implications to programmes could be major,” he said.

To shorten the treatment regimen, the TRC team simply replaced one of the four drugs in the cocktail, ethambutol, with a more powerful drug oflaxacin.

While ethambutol simply weakens the tuberculosis bacteria, its replacement kills them ¡ which is proving crucial. The researchers retained the other three DOTS drugs.

A TRC study on 416 fresh cases in Chennai and Madurai, also in south India, showed that an ultra-short three-month regimen with Ofloxacin cured 99 percent patients of , with an 8 percent relapse rate.

ôA relapse rate of 8 percent is considered highly acceptable as usually, relapse rates of 20 percent are reported,” said TRC scientist M Shaheed Jawahar.

Since the 1990s, DOTS has been the cornerstone of a fight against an ancient disease that seems to have suddenly gained resurgence partly due to the development of resistance by the concerned bacterium to common antibiotics.

DOTS is designed to carefully monitor each patient’s progress while being treated with a potent combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of six months or a complete certifiable cure is achieved.

Currently, more than 56 percent of what WHO’s South-east Asia region which includes India, Indonesia and Bangladesh, has access to DOTS and nearly two million patients have been treated so far with it.

Despite the proven results of this regimen, the six months needed for DOTS are too long for many poor patients to comply with and cumbersome to implement under control programmes, say TRC researchers.

Patients who do not take the full course of the treatment not only are likely to suffer relapses but they development multi-drug resistant strains of the TB bacteria called MDRTB.

Multi-drug resistance is, in fact, compounding the TB problem in many countries since it is harder and more expensive to treat. TRC estimates that multi-drug resistant TB is at least 100 times more expensive to cure than ordinary TB.

ôIn countries that are poor, multi drug resistant TB that cannot be treated with standard medicines can be a death sentence,” a TRC scientist said. ôOur result is, in fact, a shorter DOTS. We think the implications are quite significant,” he said.

The finding could have enormous implications for global management of tuberculosis, Jawahar observed.

Shortening treatment has been a long-term goal in TB research. From 18 to 24 months when TB treatment first became available in the 1950s, clinical trials in India and other parts of the world have helped to gradually shorten the duration first to 12 months, then nine months and finally six months.

India was ironically the seedbed where the idea of DOTS took root, when TRC initially demonstrated that even destitute people living in slums of Chennai (then called Madras) could be successfully treated with regular supervised course of inexpensive anti-TB drugs.

But the efficacy of DOTS was most dramatically proved in affluent cities like New York, where there has been TB resurgence possibly as an opportunistic infection associated with rising HIV prevalence.

But the disease is typically associated with poverty and malnutrition common in developing countries.

In Bangladesh in fact, some locals wryly call TB the ôking’s disease” ¡ or ‘Raja Rog’ ¡ because only kings can afford to contract it.

TB and malaria are among the major poverty-determined diseases. They in turn deepen poverty, further marginalising the poor and depriving them the opportunities for good health.

In fact, this year, WHO’s theme for World TB Day on Mar. 24 was ôStop TB, Fight Poverty”.

India alone has more than 3.5 million tuberculosis cases that account for 30 percent of the global burden of the disease. The TRC estimates that half a million Indians die from the disease every year — or more than 1,000 cases every month or one every minute.

India tops the tuberculosis burden of WHO’s South-east Asia region, which has 40 percent of the world’s 8.7 million new cases every year. The region reports three million new cases and nearly three-quarter of a million deaths each year, says the WHO.

Financial losses sustained in the region alone are estimated at six billion U.S. dollars. TB is estimated to take an annual economic toll equivalent to 12 billion U.S. dollars from the incomes of poor communities.

Excerpt:

By Ranjit Devraj
NEW DELHI, Aug 13 2002 (IPS)

Indian scientists have come up with a short regimen against tuberculosis (TB) that halves the six months needed under the directly observed treatment short course or DOTS, approved by the World Health Organisation (WHO).

Because it is shorter, the new regimen developed at the Tuberculosis Research Centre (TRC) in southern Chennai city, reduces the morbidity and poor compliance associated with DOTS, which relies on the closely supervised administration of a cocktail of four cheap but powerful drugs.

‘’Shorter TB treatment regimens would ease drug administration for both patients and providers,” said Shaheed Jawahar, a member of the team at the TRC that developed the new regimen.

Results of the TRC research, released in May, has since been described as ôvery promising” by an expert at the WHO’s South East Asia Regional Office (SEARO) here. ‘’If the evidence is confirmed, implications to programmes could be major,” he said.

To shorten the treatment regimen, the TRC team simply replaced one of the four drugs in the cocktail, ethambutol, with a more powerful drug oflaxacin.

While ethambutol simply weakens the tuberculosis bacteria, its replacement kills them ¡ which is proving crucial. The researchers retained the other three DOTS drugs.

A TRC study on 416 fresh cases in Chennai and Madurai, also in south India, showed that an ultra-short three-month regimen with Ofloxacin cured 99 percent patients of , with an 8 percent relapse rate.

ôA relapse rate of 8 percent is considered highly acceptable as usually, relapse rates of 20 percent are reported,” said TRC scientist M Shaheed Jawahar.

Since the 1990s, DOTS has been the cornerstone of a fight against an ancient disease that seems to have suddenly gained resurgence partly due to the development of resistance by the concerned bacterium to common antibiotics.

DOTS is designed to carefully monitor each patient’s progress while being treated with a potent combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of six months or a complete certifiable cure is achieved.

Currently, more than 56 percent of what WHO’s South-east Asia region which includes India, Indonesia and Bangladesh, has access to DOTS and nearly two million patients have been treated so far with it.

Despite the proven results of this regimen, the six months needed for DOTS are too long for many poor patients to comply with and cumbersome to implement under control programmes, say TRC researchers.

Patients who do not take the full course of the treatment not only are likely to suffer relapses but they development multi-drug resistant strains of the TB bacteria called MDRTB.

Multi-drug resistance is, in fact, compounding the TB problem in many countries since it is harder and more expensive to treat. TRC estimates that multi-drug resistant TB is at least 100 times more expensive to cure than ordinary TB.

ôIn countries that are poor, multi drug resistant TB that cannot be treated with standard medicines can be a death sentence,” a TRC scientist said. ôOur result is, in fact, a shorter DOTS. We think the implications are quite significant,” he said.

The finding could have enormous implications for global management of tuberculosis, Jawahar observed.

Shortening treatment has been a long-term goal in TB research. From 18 to 24 months when TB treatment first became available in the 1950s, clinical trials in India and other parts of the world have helped to gradually shorten the duration first to 12 months, then nine months and finally six months.

India was ironically the seedbed where the idea of DOTS took root, when TRC initially demonstrated that even destitute people living in slums of Chennai (then called Madras) could be successfully treated with regular supervised course of inexpensive anti-TB drugs.

But the efficacy of DOTS was most dramatically proved in affluent cities like New York, where there has been TB resurgence possibly as an opportunistic infection associated with rising HIV prevalence.

But the disease is typically associated with poverty and malnutrition common in developing countries.

In Bangladesh in fact, some locals wryly call TB the ôking’s disease” ¡ or ‘Raja Rog’ ¡ because only kings can afford to contract it.

TB and malaria are among the major poverty-determined diseases. They in turn deepen poverty, further marginalising the poor and depriving them the opportunities for good health.

In fact, this year, WHO’s theme for World TB Day on Mar. 24 was ôStop TB, Fight Poverty”.

India alone has more than 3.5 million tuberculosis cases that account for 30 percent of the global burden of the disease. The TRC estimates that half a million Indians die from the disease every year — or more than 1,000 cases every month or one every minute.

India tops the tuberculosis burden of WHO’s South-east Asia region, which has 40 percent of the world’s 8.7 million new cases every year. The region reports three million new cases and nearly three-quarter of a million deaths each year, says the WHO.

Financial losses sustained in the region alone are estimated at six billion U.S. dollars. TB is estimated to take an annual economic toll equivalent to 12 billion U.S. dollars from the incomes of poor communities.

Excerpt:

By Ranjit Devraj
NEW DELHI, Aug 12 2002 (IPS)

Indian scientists have come up with a short regimen against tuberculosis (TB) that halves the six months needed under the directly observed treatment short course or DOTS, approved by the World Health Organisation (WHO).

Because it is shorter, the new regimen developed at the Tuberculosis Research Centre (TRC) in southern Chennai city, reduces the morbidity and poor compliance associated with DOTS, which relies on the closely supervised administration of a cocktail of four cheap but powerful drugs.

‘’Shorter TB treatment regimens would ease drug administration for both patients and providers,” said Shaheed Jawahar, a member of the team at the TRC that developed the new regimen.

Results of the TRC research, released in May, has since been described as ôvery promising” by an expert at the WHO’s South East Asia Regional Office (SEARO) here. ‘’If the evidence is confirmed, implications to programmes could be major,” he said.

To shorten the treatment regimen, the TRC team simply replaced one of the four drugs in the cocktail, ethambutol, with a more powerful drug oflaxacin.

While ethambutol simply weakens the tuberculosis bacteria, its replacement kills them ¡ which is proving crucial. The researchers retained the other three DOTS drugs.

A TRC study on 416 fresh cases in Chennai and Madurai, also in south India, showed that an ultra-short three-month regimen with Ofloxacin cured 99 percent patients of , with an 8 percent relapse rate.

ôA relapse rate of 8 percent is considered highly acceptable as usually, relapse rates of 20 percent are reported,” said TRC scientist M Shaheed Jawahar.

Since the 1990s, DOTS has been the cornerstone of a fight against an ancient disease that seems to have suddenly gained resurgence partly due to the development of resistance by the concerned bacterium to common antibiotics.

DOTS is designed to carefully monitor each patient’s progress while being treated with a potent combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of six months or a complete certifiable cure is achieved.

Currently, more than 56 percent of what WHO’s South-east Asia region which includes India, Indonesia and Bangladesh, has access to DOTS and nearly two million patients have been treated so far with it.

Despite the proven results of this regimen, the six months needed for DOTS are too long for many poor patients to comply with and cumbersome to implement under control programmes, say TRC researchers.

Patients who do not take the full course of the treatment not only are likely to suffer relapses but they development multi-drug resistant strains of the TB bacteria called MDRTB.

Multi-drug resistance is, in fact, compounding the TB problem in many countries since it is harder and more expensive to treat. TRC estimates that multi-drug resistant TB is at least 100 times more expensive to cure than ordinary TB.

ôIn countries that are poor, multi drug resistant TB that cannot be treated with standard medicines can be a death sentence,” a TRC scientist said. ôOur result is, in fact, a shorter DOTS. We think the implications are quite significant,” he said.

The finding could have enormous implications for global management of tuberculosis, Jawahar observed.

Shortening treatment has been a long-term goal in TB research. From 18 to 24 months when TB treatment first became available in the 1950s, clinical trials in India and other parts of the world have helped to gradually shorten the duration first to 12 months, then nine months and finally six months.

India was ironically the seedbed where the idea of DOTS took root, when TRC initially demonstrated that even destitute people living in slums of Chennai (then called Madras) could be successfully treated with regular supervised course of inexpensive anti-TB drugs.

But the efficacy of DOTS was most dramatically proved in affluent cities like New York, where there has been TB resurgence possibly as an opportunistic infection associated with rising HIV prevalence.

But the disease is typically associated with poverty and malnutrition common in developing countries.

In Bangladesh in fact, some locals wryly call TB the ôking’s disease” ¡ or ‘Raja Rog’ ¡ because only kings can afford to contract it.

TB and malaria are among the major poverty-determined diseases. They in turn deepen poverty, further marginalising the poor and depriving them the opportunities for good health.

In fact, this year, WHO’s theme for World TB Day on Mar. 24 was ôStop TB, Fight Poverty”.

India alone has more than 3.5 million tuberculosis cases that account for 30 percent of the global burden of the disease. The TRC estimates that half a million Indians die from the disease every year — or more than 1,000 cases every month or one every minute.

India tops the tuberculosis burden of WHO’s South-east Asia region, which has 40 percent of the world’s 8.7 million new cases every year. The region reports three million new cases and nearly three-quarter of a million deaths each year, says the WHO.

Financial losses sustained in the region alone are estimated at six billion U.S. dollars. TB is estimated to take an annual economic toll equivalent to 12 billion U.S. dollars from the incomes of poor communities.

Excerpt: