Using Old Medications to Defeat Tuberculosis 70
TastesLikeCoughSyrup writes "Antibiotic resistant tuberculosis is spreading like wildfire in the developing world. While many researchers are looking for new drugs to combat the disease, those efforts could take years to bear fruit. Meanwhile, two scientists at the Albert Einstein College of Medicine have learned how the drug clavulanate can destroy the defenses of tuberculosis, making it vulnerable to medications in the penicillin family. The best part: it has already been approved by the FDA so doctors can start using it immediately."
Links to actual papers for more info ... (Score:5, Informative)
Can't say I understand this stuff, but for those who do, these probably should have been in the story snippet.
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I am a firm believer in that all species have their appropriate ecological niche somewhere. In the case of diseases like TB and smallpox, that niche is in a small glass vial deep in a highly secure underground bunker.
OTOH, if you want to see a really scary disease
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captain obvious (Score:5, Funny)
I don't think fruit is going to help against tuberculosis.
beta-lactamase inhibitor (Score:5, Informative)
http://en.wikipedia.org/wiki/Clavulanate
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it is actually not very initutive for us to think about penicillin group of antibiotics when we are faced with TB.
Damn bastards! (Score:3, Funny)
Those of us allergic to penicillin will simply evolve and grow gills. So while you all cling to your antibiotics and inhibitors on the poisoned land, me and my brothers and sisters will be ruling the sea!
Re:Damn bastards! (Score:4, Funny)
Long Term (Score:1)
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And for the record I'm allergic to penicillin as well. And it sucks.
Think I'm missing something (Score:2)
Isn't that Augmentin [wikipedia.org]? How would this be different?
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piperacillin-tazobactam (zosyn) is another
ampicillin-sulbactam (unasyn)
this said, one can choose to combine any of the beta-lactamase inhibitors with a beta-lactam antibiotic (PCN or cephalosporin) of their choice though in reality one would most likely go with one of the above cominations as they have been clinically tested.
Was going to post separately, b
FDA??? (Score:2)
>
AFAIK, the USA's FDA has no authority over the developing world. Doctors in the developing world can start using any drug as soon as they like (or their own authorities allow).
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Incidentally, doctors won't start using it immediately for that as far
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Chest X-Rays required for immigration (Score:4, Interesting)
Each of us were required to have chest X-Rays. My understanding is that if they showed that either of us had tuberculosis, our visas would be denied.
However, the doctor who gave me my medical exam - which was rather thorough - told me that I should show my passport to the X-Ray technician, just to make sure someone else wasn't able to stand in for me. I offered it to her, but she didn't bother with it.
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The Canadian govt encourages immigration (Score:2)
Immigration is held out as a solution to Canada's aging population - they have baby boomers just like the US, and there aren't enough young native-born workers to pay for the pensions and medical care of the elderly.
I spent a year in Vancouver, BC. It was full of immigrants from all over the world.
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Amoxicillin-Potassium Clavulanate Combination (Score:4, Informative)
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As others have noted, this is not a new drug combination. It's currently sold under the brand name of Augmentin [augmentin.com]
In other news... (Score:3, Interesting)
One thing I have done is made Manuka honey mead, which is interesting as it means that either I destroyed the antibacterial agent when using heat to dissolve the honey, or the agent has no significant ability to slow yeast cultures.
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Cheaper too I presume... (Score:1)
Here's hoping it actually gets to poor people (Score:5, Insightful)
However, I take encouragement from two things about this:
First is that it's an older drug, which means it will probably be off-patent soon (anyone know?). This should guarantee it's fairly affordable. Also, it's a proven drug with a clean track record so far. Both of those mean that governments like Tanzania are more likely to implement it's use for TB.
Second is that it may (and I'm speculating here) shorten the treatment time for TB. That could be big. Current treatment time is on the order of months, if the drugs are more effective then it follows that the treatment might be shorter. That would be good for compliance: In the rich world it's hard to get people to take pills regularly for months on end, and it's no different anywhere else. People forget, or they feel better and don't think they have to continue, it happens.
Tanzania has a TB control program which provides free medicine and Tanzanians can take medicine just as well as the rest of us. Sadly, rural clinics often don't have enough drugs to give out a whole course of treatment to everyone, so people have to return for more pills, and again for check-ups. That often means a large disruption in daily life (imagine walking an entire day to get to a clinic, then going back), and the decisions presented are not easy: skipping work regularly to go get your medicine/checkup could impact your crop, your herd, get you fired etc. I wonder how many cases of TB have relapsed or spread due to this sort of coerced non-compliance? Less disruption is a win on all fronts.
On a less serious note, I am reminded of a particularly bad cross-country trip where I was crammed in the back of a ricketty Land Rover 110 with at least 12 people (just in the back compartment, I think the total headcount was over 20, not counting chickens). I was directly across a man who was a textbook case of kifua kikuu (TB), and the ride was almost 12 hours, with breakdowns. At a certain point, I just resigned myself to catching it.
Amazingly, I didn't. I didn't get malaria once either.
But in the end, malaria, TB and HIV were about the only things I didn't get at some point.
Any other RPCV Slashdoters?
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You bet they did. I'm sure you are aware of this, but others should know a doctor and judge can have a person locked up in JAIL and forced to take the meds if they decide to be non-compliant with TB treatment. I think TB is the only disease where this allowed. It happened in my hometown a few years back, according to the old-timers at the sheriff's office.
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All in all, I'm just darn happy I didn't get it.
This article seems to be missing something... (Score:3, Informative)
Apparently nobody really has tried beta-lactam antibiotics in this indication, but it seems suprising that any medical professional would consider this a "one-two punch strategy". Realistically this would be one combo of a multi hit process. Modern day TB therapy always includes a specifically chosen 3-4 drug combination. This combination depends on where the infection was contracted along with any characterisation of the strain that is possible. This is simply because if you feed a drug that's not killing it, you're selecting for resistance to that drug. If physicians start using beta-lactamase inhibitors they'd better be careful because there are already several examples of other infections resistant to clavulanic acid (just google search).
Whilst the article reports this as if it is a major breakthrough, this is purely sensationalism. It is a minor breakthrough in a major problem.
No money in old medicines (Score:2)
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There's no money in using old medicines, this is why they drug companies are always inventing new ones. Once a drug has been copied and sold by other companies then the price comes right down.
Yeah, it has nothing to do with the fact that there are illnesses that we don't have a good treatment for. That's why nobody makes aspirin or penicillin anymore. Oh wait, lots of companies produce both.
Drug companies develop new drugs because there is a lot of money to be made from a new drug which provides a treatment for something that is significantly better than existing treatments. However, most of the cost of a drug is the initial R&D, so once that is paid off, you don't need all that high of a
Interesting, but no guarantees here. (Score:4, Informative)
Clinical utility is the Holy Grail here - the biochemical activity of a drug is critical, but the effect of the drug on the infection in an infected person is a lot more complicated. You have to get an effective concentration of the antibiotic into the area of the organism, get the bug to take up appropriate quantities of it, and not injure the patient in the process. Every step of this can kill an otherwise promising use of the drug.
In the case of clavulanate, we know that it causes significant side effects. I use it a LOT in kids (Augmentin is your friend for a variety of conditions, and clavulanate is what makes Augmentin Augmentin), and it causes pretty impressive diarrhea at fairly low doses. Diarrhea, especially if it involves altered intestinal flora, is a set-up for C. difficile colitis, which can be deadly. If we need high concentrations of clavulanate, we may not be able to give enough of it to patients. Or there may be other toxicities, although it's been quite benign in widespread use to date.
Another problem is that the bacterium can mutate proteins to avoid drugs, and TB is pretty good at this. MDR TB didn't happen by accident, and mutation of beta-lactamases to avoid clavulanate is not unheard of. Overproduction of the enzyme is also possible, and would then increase the required dose of the drug (and see above).
A final problem is the physical defenses of the bug. The cell wall for TB is quite effective and strong, and the bacterium has a variety of transport mechanisms to get antibiotics out of the cell. Again, we may not be able to get enough clavulanate into the cell long enough to kill it.
Having said all of that, I'm delighted both that the work is being done and that these initial results are promising. It will be fun to see what happens clinically.
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Similar to a technique for treating Lyme Disease (Score:1)
Already approved?? (Score:1)