Tuberculosis: International study on antibiotic resistance

Focus on identifying resistance genes


Hopes for tuberculosis treatment have been raised by an international study in which DZIF scientists from the Research Center Borstel were also involved. Resistance to pyrazinamide und fluoroquinolones was analysed in almost 5,000 tuberculosis patients, showing, amongst other things, that all newer, fourth-generation fluoroquinolones only had low levels of resistance. The results of the analysis are published in The Lancet.

With an estimated 9.6 million new cases of tuberculosis and 1.5 million deaths in 2014, tuberculosis (TB) continues to be a major global health problem together with HIV. Additionally, TB bacteria with different types of antibiotic resistance, including both multi and extensively resistant forms, are increasing in different parts of the world. An international study has now investigated the resistance situation in countries with high rates of TB and high levels of resistance. Around 5,000 tuberculosis patients from Azerbaijan, Bangladesh, Pakistan, South Africa and Belarus were investigated for resistance to pyrazinamide und fluoroquinolones.

For many years, pyrazinamide has been used in combination with rifampicin, ethambutol and isoniazid to treat tuberculosis and reduce the duration of TB treatment. Fluoroquinolones are only used in particularly severe cases due to their potentially severe side effects.

The analysis showed that pyrazinamide resistance varied and was frequently accompanied by rifampicin resistance. Nevertheless, pyrazinamide was still effective in 19 to 63 percent of rifampicin resistant patients, hence opening up treatment options. An important and encouraging finding was that all fourth-generation fluoroquinolones only showed low levels of resistance.

“The findings of this study are of critical importance for developing efficient treatment and diagnostics in the different study regions,” says Prof Stefan Niemann, Head of the Molecular and Experimental Mycobacteriology Research Group at the Research Center Borstel and of the research field “Tuberculosis”.

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