Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Sanatorium by any other name
- Bernard A Foëx (8 September 2008)
-
MDR-TB Public Health Importance
- Vivek A Furtado (10 September 2008)
-
Risk factors for MDR TB
- John P Watson (7 October 2008)
|
|
|||
|
Bernard A Foëx, Consultant in Emergency Medicine and Critical Care Manchester Royal Infirmary, Manchester M13 9WL
Send response to journal:
|
Grant et al, in their excellent review of drug resistant tuberculosis, suggest where resources are limited, that cases with similar resistance could be managed in “segregated groups” and that transmission can be reduced by, “low cost interventions, such as opening windows” [1]. Why not build such a facility on a sunny mountain side, where the air is pure, and call it a sanatorium? 1. Grant A, Gothard P, Thwaites G. Managing drug resistant tuberculosis. BMJ 2008;337:564-9 Competing interests: None declared |
|||
|
|
|||
|
Vivek A Furtado, ST4 Leeds Partnership NHS Foundation Trust
Send response to journal:
|
I would like to thank the authors for the timely review (1) on MDR- TB. Having worked in a developing country myself and seen cases of MDR-TB at a time when free 2nd line medication wasn't available to those infected I feel that unavailable "free" medication was one of the vital reasons why there could have been a spread of such strains. Till recently only DOTS (which involved the use of the 1st line treatment) was available to patients diagnosed with TB. However in late 2007 a new strategy termed DOTS-PLUS (2) evolved in India which looked at treating MDR-TB and XDR-TB at a national level. This is of vital importance as cost is a major factor when it comes to 2nd line drugs (about 100 times more expensive as compared to first line). If not made available free of cost then those unable to pay would harbour the disease thus spreading it further. Even though there is no substitue to optimal treatment in non MDR-TB patients, the spread of resistant strains can be reduced with optimal and "free" treatment of those infected with resistant bacteria. (1) Alison Grant, Philip Gothard, and Guy Thwaites; Managing drug resistant tuberculosis BMJ 2008; 337: a1110 (2) http://www.tbcindia.org/Pdfs/Consensus%20statement%20on%20MDR%20XDR%20TB%20 -Final.pdf Competing interests: Doctor trained and worked in a developing country |
|||
|
|
|||
|
John P Watson, Consultant Respiratory Physician St James Universtiy Hospital, Beckett St, Leeds LS9 7TF
Send response to journal:
|
In their otherwise excellent review of the management of MDR Tuberculosis, Grant et al continue to quote the risk factors for MDR TB as listed in the NICE guidelines [1], and rightly emphasise the importance of a prior history of TB treatment. However, recent evidence suggests that at least in the UK HIV infection is not an independant risk factor for MDR TB [2]. London may have a higher rate of MDR TB than the rest of the UK as a whole, but in the last 2 years for which data is available (2005 and 2006) the proportion of TB isolates with MDR has been as high or higher in North West England and in Yorkshire and the Humber as it was in London [3]. While it remains true that the risk is higher in those born outside the UK, this is of limited clinical help as over two thirds of TB patients fall into this categaory. Clinicians should be alert to the possibility of drug resistance in any TB patient in any part of the UK, not just those falling into "traditional" risk groups. Culture and sensitivity testing should be obtained for all patients whenever possible. References. 1. National Insitute for Health and Clinical Excellence. Tuberculosis. Clinical diagnosis and management of tuberculosis and measures for its prevention and control. 2006. www.nice.org.uk/CG033 2. French CE, Glynn JR et al. The association between HIV and antituberculosis drug resistance. Eur Respir J 2008; 32:718-725. 3. Health Protection Agency. www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1204100463368 [accessed 6/10/2008]. Competing interests: None declared |
|||