A new drug regime that shortens the treatment for multi-drug resistant tuberculosis from two years to nine months has been recommended for use by the World Health Organisation, raising hopes that hundreds of thousands of people will stay the course and be cured.

About 480,000 people are estimated by the WHO to have this form of the infectious disease, which has been found in every country in the world and kills 190,000 every year. MDR-TB cannot be cured by the standard six-month regimen of antibiotics because the bacteria have become resistant to some or all of the drugs, meaning they no longer work.

The existing course of combined heavy-duty antibiotics used against MDR-TB lasts up to two years and there are toxic side-effects to some of the drugs, causing deafness and other problems. About half of those put on the treatment give up, raising the risk that their disease will return and spread to other people.

The WHO announced two innovations that it hopes will dramatically change this scenario. It recommended a rapid diagnostic test, which can detect how resistant the patient’s form of TB is, and a shorter course of treatment which lasts between nine and 12 months. For MDR-TB, patients can take a less toxic combination than for XDR-TB – the extremely resistant form.

“This is a critical step forward in tackling the MDR-TB public health crisis,” said Dr Mario Raviglione, the director of the WHO’s global TB programme. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”

The regimen has not gone through formal clinical trials, but was developed by a number of organisations working on TB and tried successfully in 515 patients in Bangladesh between 2005 and 2011, and then on 408 people in a number of African nations. It is now being tested in an official clinical trial in Mongolia.

The WHO, however, said it felt there was already enough information to recommend the use of the shorter treatment regimen. “We have decided to accelerate the procedure because we believe that these tools have real potential to save lives immediately,” Raviglione told the Guardian. The 24-month regimen had not been tested in a clinical trial either, he said. However, the body would be looking for confirmation of the new advice from the Mongolian study.

“The basis of all this is how terrible the current treatment is – in 24 months 14,000 pills have to be taken by one person. Less than 50% who take the current treatment are cured. In 2016, that is what we are still dealing with,” said Dr ID Rusen, a senior vice-president in the International Union against Tuberculosis and Lung Disease, which has been developing the shorter regimen.

Cure rates are much higher with the shorter course of treatment – more than 80%, compared with 50%. In Bangladesh, he said, “it was almost too good to be true. How could we get 85-86% treatment success when we were struggling with the current regimen?”

Philipp du Cros, the head of the Manson Unit at Médecins Sans Frontières, which provides medical support and research for the charity’s field operations, said the recommendations were a promising step forward and countries should act on them immediately.



“MSF has seen positive outcomes using a nine-month regimen for some people with DR-TB (drug-resistant TB) in countries such as Swaziland and Uzbekistan,” he said. “However, these shorter regimens still use some of the old, toxic drugs, particularly the daily painful injections people must endure. Today’s announcement must not lead us to lose sight of the desperate need for completely new treatment regimens.”

