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Why Is TB Still Such a Big Threat in the United States?

One of the toughest aspects of the disease is resistance. MDR TB refers to M. tuberculosis that is resistant to isoniazid and rifampin, the two core backbone agents used for treatment. XDR TB describes M. tuberculosis that is resistant to isoniazid and rifampin as well as a fluoroquinolone and one of the three second line intravenous agents available. The regimens utilized under these circumstances are challenging, usually require intravenous or intramuscular administration, and have significant adverse effects. Not only are these regimens more difficult to formulate based on the resistance patterns of the isolate, but they are also prolonged, with courses lasting up to 2 to 3 years. In 2014, 91 cases of MDR and 2 cases of XDR TB were identified in the United States.5
Lessons learned from recent outbreaks of other infectious diseases, such as Ebola, Zika, and MDR gram-negative bacteria, throughout the world demonstrate that there is no fail-safe way to stop the entrance of pathogens into the United States. As Hans Zinsser stated in the 1930s, “But however secure and well-regulated civilized life may become, bacteria, protozoa, viruses, infected fleas, lice, ticks, mosquitoes, and bedbugs will always lurk in the shadows ready to pounce when neglect, poverty, famine, or war lets down the defenses.” Efforts to limit the spread of TB need to continue at all levels and in all places to inhibit its potential for widespread morbidity and mortality. Further research to make identification more rapid, education to promote awareness and infection control practices, and the development of antimycobacterials that demonstrate efficacy and better tolerability, with shorter courses, over the current regimens are all vital to ending TB not only in the United States, but around the world. 
 Dorothy McCoy, PharmD, BCPS-AQ ID, is currently the infectious diseases/ antimicrobial stewardship clinical pharmacist at Saint Joseph’s Regional Medical Center in Paterson, NJ. She received her doctor of pharmacy degree from the Ernest Mario School of Pharmacy (EMSOP) at Rutgers University, and added qualifications in infectious diseases pharmacotherapy from the Board of Pharmaceutical Specialties. She has been an active member of the Society of Infectious Diseases Pharmacists, serving on multiple committees within the organization, and is also involved in the American College of Clinical Pharmacy, American Society of Health-System Pharmacists, and the NJ Society of Health-System Pharmacists.    
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8. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Disease Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147-195. doi: 10.1093/cid/ciw376.

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