Whatʼs in a name? The future of drug-resistant tuberculosis classification

By Sophie Beauvais | 12 Jun, 2013

By Timothy Sullivan, Yanis Ben Amor

Due to a recent resurgence in tuberculosis research focused on drug development, several new anti-tuberculosis drugs are in the pipeline, and the standard of care for tuberculosis might soon change. If new drugs replace the current first-line treatment, then existing classifications of resistance, including multi drug-resistant and extensively drug- resistant tuberculosis, might become
less relevant. When much needed new drugs reach the market, a new classification system for resistance might need to be devised to describe resistance to these novel agents. Many options for such a system exist, each with its own inherent benefits and challenges. The adoption of new terminology for resistance should be guided by outcomes data from clinical trials in progress,
and should be accompanied by increased support for drug susceptibility testing in developing countries to be clinically useful. Consideration of these issues now will hopefully help foster an informed approach to the classification of drug-resistant tuberculosis in the era of new drugs.

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Kathleen England Replied at 2:34 PM, 12 Jun 2013

I think that there are too many acronyms and labels already in the world of TB. It might be best to just categorize people as either drug susceptible (relating to standard DOTS regimen) or drug resistant. As we progress with new drugs and new treatment regimens, we must focus on individualized treatment programs according patient DST profiles for the most effective individual treatment plan. Standardized regimens make treatment simpler, but are not always right for each patient. The complexity of drug resistance has and will increase as we introduce new options for chemotherapy.

Erica Lessem Replied at 2:40 PM, 12 Jun 2013

Thanks for sharing, and I agree with Kathleen that the classifications of
MDR, pre-XDR, XDR are confusing to those outside TB. As the authors
indicate, the clinical significance behind these classifications may also
become obsolete.

I am really glad the authors point to the need for rapid, reproducible,
affordable DST. I think it would be ideal for TB to have the tools to
better follow the HIV model of using individual drug susceptibility data to
guide individualized treatment regimens. Most second-line TB treatment
options are lengthy, toxic, and hard to tolerate-- more drug options and
fewer unnecessarily administered ineffective drugs would spare patients and
providers alike a lot of trouble.