Treatment Default

Treatment default is one of the biggest problems in the treatment of tuberculosis today. We may already find it difficult to adhere to a 7-day antibiotic treatment regimen in that case of a simple pneumonia. TB patients have to go through their treatment several times a week for at least half a year. Compounding this difficulty with the lack of education on the possible consequences of treatment default, which often exists among TB patients in the developing countries, only worsens the issue, which is cited to be the largest driver of drug resistance.

Due to the prolonged treatment duration of 6-8 months, patients often decide to abandon treatment mid-way, especially since the symptoms of the disease usually subside after about 2 months, while the side effects of the various antibiotics persist. In the past, this had led to the emergence of drug-resistance rendering traditional TB medication ineffective to cure the new type of TB. In response, the World Health Organization (WHO) developed the Directly Observed Treatment Short-course (DOTS) guidelines, in which anti-TB medication has to be administered in accordance to these guidelines and under strict supervision of a physician or certified healthcare provider.

Whether the patients rely on the fact that the disease has been overcome, they have no time or energy for the constant visits to the doctor’s office or they cannot afford the drugs for lack of insurance and public health facilities, this individual failure has escalated tuberculosis to an intimidating new dimension. And with increasing globalization and immigration, but also with rising narcotics abuse, growing HIV/AIDS prevalence and escalating numbers of homelessness, the problem is once again threatening to become a global epidemic. In Eastern Europe and Russia, for example, it is estimated that at least one in five TB incidences is of the drug-resistant type.

And even among MDR-TB patients, whose treatment takes 18-24 months, is about 2000 times as expensive, and triggers side effects with greater frequency, variety and severity, treatment default has now led to the development of yet more drug-resistant strands (Extensively Drug-Resistant “XDR-TB” and Extremely Drug-Resistant TB or “XXDR-TB”), for which currently no truly effective therapies exist. Little help can be provided for these patients other than simple symptom management in a sanitarium. The fact that XDR is on the rise can be shown by the registration of at least one XDR-TB case in almost all countries – including the western world.

In our evaluation of potential partner organizations, their focus on treatment compliance and their capabilities in preventing and retrieving defaults are key criteria we assess prior to committing to a partnership.

Hollywood movies like Outbreak, 28 Days Later and Contagion make headlines with the dramatization of the outbreak of killer germs, but reports on the possible epidemic of our real-life true super bacteria remain largely unnoticed. Perhaps the reason for this is the low probability of infection and outbreak for us. Either way, the general indifference about this  forgotten disease has made it possible that one day soon it might also return to the western world and become a serious problem. Read more about the lack of attention in the next and final section.

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