Given that India has the highest burden for tuberculosis (TB) in the world, it is welcome news that scientists in India and the US have managed to modify a precursor to an existing anti-TB drug. This will now aid the development of new antibiotics that can be used against drug-resistant TB. The new analogue of this drug is a significant breakthrough in the treatment of the virulent forms of TB. One of the main reasons of the lacklustre performance of India’s current campaign against TB is that a bulk of the patients, usually from the lower economic sections, often stop medication at the first sign of recovery. Since the new drug brings down the course of treatment, more patients are likely to complete the course, thereby checking the spread of MDR and XDR TB.
If it works—and it has been successful in smaller trials—the new trial announced by the global TB Alliance will be carried out by partners around the world. It will cut the length of a course of pills for TB from six months to four and for MDR-TB from 18-24 months down to six. There will be no more need for daily injections for MDR-TB, and the Alliance says the patients will be taking maybe 360 pills or less instead of more than 14,000 over the course of their treatment, as now, and the drugs will be less toxic. TB kills 1.4 million people a year. The old drugs—half a century old—are no longer adequate.
In 1993, resurgent levels of TB due to the antibiotic resistance led the WHO to declare it a global health emergency. But not much has changed in the intervening years. There is, however, considerable promise in the new regimen and the secret will lie in a concerted drive to defeat the drug resistance in rifampicin and related antibiotics through a new compound with a combination of genetic modification and synthetic drug development. It is heartening that India is engaged with the US to devise the new compound but more vigorous efforts are needed.