Mycobacteria: II Chemotherapy

451 Pages·1998·8.625 MB·English

by  Nils E. Billo (auth.), Pattisapu R. J. Gangadharam Ph.D., P. Anthony Jenkins Ph.D. (eds.)

M~co~acteria
II CHfMOTHfRAPY
JOIN US ON THE INTERNET
WWW: http://www.thomson.com
EMAIL: [email protected]
thomson. com is the on-line portal for the products, services and resources available from
International Thomson Publishing (ITP). This Internet kiosk gives users immediate access to
more than 34 ITP publishers and over 20,000 products. Through thomson. com Internet users
can search catalogs, examine subject-specific resource centers, and subscribe to electronic
discussion lists.You can purchase ITP products from your local bookseller, or directly
through thomson. com.
Visit Chapman & Hall's Internet Resource Center for information on our new publications,
links to useful sites on the World Wide Web and the opportunity to join our e-mail
mailing list. Point your browser to: http://www.chaphall.com or
http://www.thomson.com/chaphall/lifesce.htmlfor Life Sciences
A service of I(!)P
cteria
M~co ~a
IT
CHfMOTHfRAPY
CHAPMAN & HAll MEDICAL MICROBIOLOGY SERIES
Edited by
Pattisa~u R. J. GANGADHARAM, PH.D.
Professor of Medicine, Microbiology, and Pathology
Director of My co bacteriology Research,
University of Illinois at Chicago College of Medicine, Chicago, illinois
P. J[NKINS, PH.D.
Ant~onr
formerly Director, Public Health Laboratory Service,
University Hospital of Wales, United Kingdom
Springer-Science+Business Media, B.V
IOOF
International Thomson Publishing
Thomson Science
't'w York· Alhany • Bonn. Boston. Cincinnati. Detroit. • Lundon • Madrid • ~ldbuurIl{,
Mexico (:ity • Pacific Grove· Pari., • SdTI Francis(o.o • Sill~apOrf' • Tokyo. Tornnlo • Washjngton
Cover design: Trudi Gershenov
Copyright © 1998 by Springer Science+Business Media Dordrecht
Originally published by Chapman & Hall in 1998
Softcover reprint of the hardcover I 5t edition 1998
All rights reserved. No part of this book covered by the copyright hereon may be reproduced or used in
any form or by any means-graphic, electronic, or mechanical, including photocopying, recording, taping,
or information storage and retrieval systems-without the written permission of the publisher.
1 23456789 10 XXX 01 009998
Library of Congress Cataloging-in-Publication Data
Mycobacteria 1 edited by P.R.J. Gangadharam, P.A. Jenkins.
p. cm. --(Chapman & Hall medical microbiology series)
Includes bibliographical references and index.
Contents: v. 1. Basic aspects - v. 2. Chemotherapy.
ISBN 978-1-4615-7513-9 ISBN 978-1-4615-7511-5 (eBook)
DOI 10.1007/978-1-4615-7511-5
1. Mycobacterial diseases. I. Gangadharam, Pattisapu Rama Jogi,
Il. Jenkins, P.A., (P. Anthony) 1II. Series
{DNLM: 1. Tuberculosis, Pulmonary. 2. Mycobacterium Infections.
3. Mycobacterium. WF 300 M995 1997)
QR201.M96M93 1997
616' .01474--dc21
DNLM/DLC
for Library of Congress 97-3970
CIP
British Library Cataloguing in Pubication Data available
To order this or any other Chapman & Hall book, please contact International Thomson Publishing,
7625 Empire Drive, Florence, KY 41042. Phone: [phone] or 1-800-842-3636.
Fax: [phone]. e-mail: [email protected].
For a complete listing of Chapman & Hall's titles, send your request to Chapman & Hall, Dept. BC,
115 Fifth Avenue, New York, NY 10003.
To My Parents,
Mr. Pattisapu Venkata Joga Rao
Mrs. Pattisapu Karneswaramma
Who, despite of the great fear that I may become a serious victim to this dreadful
disease, inspired me to continue research in this field.
Pattisapu Rama Jogi Gangadhararn
To,
The Staff of the Tuberculosis Reference Laboratory (1959-1977) and the My
cobacterium Reference Unit (1977-1995) in the Public Health Laboratory, Cardiff
who contributed so much to the quality of clinical mycobacteriology in the United
Kingdom.
P. Anthony Jenkins
v
Contents
Preface ix
Acknowledgments Xlll
Contributors xv
Biographical Sketches of Dr. PRJ. Gangadharam and Dr. P.A. Jenkins XVll
1. GLOBAL ASPECTS OF TUBERCULOSIS
Nils E. Billo
2. BASIC CONCEPTS IN THE CHEMOTHERAPY OF
TUBERCULOSIS
D.A. Mitchison 15
3. EXPERIMENTAL CHEMOTHERAPY OF MYCOBACTERIAL
DISEASES
Jacques Grosset and Baohong Ji 51
4. CONTROLLED CLINICAL TRIALS IN TUBERCULOSIS:
LESSONS TO BE DRAWN
S. Radhakrishna 98
5. CHEMOTHERAPY OF TUBERCULOSIS IN DEVELOPED
COUNTRIES
Asim K. Dutt and Jay B. Mehta 131
6. TREATMENT OF TUBERCULOSIS IN LOW-INCOME
COUNTRIES
Donald A. Enarson and Philip C. Hopewell 161
7. CHEMOTHERAPY OF DRUG-RESISTANT TUBERCULOSIS
IN THE CONTEXT OF DEVELOPED AND DEVELOPING
COUNTRIES
Tadao Shimao 183
8. TUBERCULOSIS AND THE ACQUIRED IMMUNODEFICIENCY
SYNDROME
R. Shaw and R.J. Coker 209
9. THE MANAGEMENT OF EXTRAPULMONARY TUBERCULOSIS
L.P. Ormerod 236
10. CHEMOTHERAPY OF NONTUBERCULOUS MYCOBACTERIAL
DISEASES
LA. Campbell, P.A. Jenkins and Richard J. Wallace 279
11. PREVENTIVE THERAPY OR TUBERCULOSIS
Lawrence J. Geiter 297
12. FAILURES IN TUBERCULOSIS CHEMOTHERAPY
Pierre Chaulet and Noureddine Zidouni 313
VII
viii Contents
13. NEW DRUGS AND STRATEGIES FOR CHEMOTHERAPY
OF TUBERCULOSIS
P.R.J. Gangadbaram 335
14. EPIDEMIOLOGY OF LEPROSY
S.K. Noordeen 379
15. TREATMENT OF LEPROSY
Baobong Ji 398
Index 425
Preface
About 30 years ago, Professor Arthur Meyers stated that if we ask the question
"Can tuberculosis be eradicated?" the answer is probably "Yes." If, on the other
hand, we ask the question, "Will tuberculosis be eradicated?" the answer will
probably be "No." This discussion was based on immunological grounds and was
written at a time when rapid progress in chemotherapy of tuberculosis was on the
horizon. At about the same time, the famous book Chemotherapy of Tuberculosis,
edited by Vincent Barry presented a series of excellent progress reports and op
timistic notes on the treatment of this disease. Unfortunately, this optimism was
misplaced and the questions posed by Meyers have become even more pertinent,
not only to the prevention or eradication, but to the overall seriousness of the
disease. The powerful tools available for the control of tuberculosis were not
properly and consistently utilized, resulting in dismal failure. The story became
a perfect example, as Frank Ryan puts it, of a major disease which could have
been conquered or, more aptly, nearly so and how soon potential victory has been
reversed.
Careful analysis of the facts has given us some insight into the successes and
failure in the control of this "curable" disease. Besides the discovery of powerful
drugs, considerable knowledge on the best possible drug regimens also became
available following tedious but excellently conducted controlled clinical trials. All
these contributions made chemotherapy the "magic bullet" in our battle against
tuberculosis. Indeed, many developed countries benefited from the advances in
chemotherapy leading to a consistent reduction in the incidence of disease in the
mid-eighties. Authorities in these countries were excited in the dramatic reduction
of the prevalence and had even set the year 2000, which was later revised to 2010
as the date for eradication. Unfortunately, this "over-excitement" resulted in a
hasty and premature abandonment of the control efforts and failure of the infra
structure, with the tragic consequence of vigorous resurgence of the disease. As
Sir John Crofton stated, "it is a sad reflection on society's incompetence to make
proper use of the tools and take control of the situation." Had it not been due to
our negligence and many pitfalls, we could have pushed tuberculosis as an old
"forgotten" disease of mankind and all the tuberculosis literature to the "archives"!
Surprisingly, even the developing and the underdeveloped countries, which never
had the fortune of witnessing any significant decline in the incidence of tuber
culosis, also became complacent and even grossly negligent in their antituber
culosis programs. These countries may have mistakenly believed that tuberculosis
is no longer serious, as many sanatoria were closed and the treatment was shifted
to domiciliary and outpatient settings. The global indifference to this dangerous
ix
x Preface
disease, which has been prevailing for a long time, prompted the International
Union Against Tuberculosis, now called the International Union Against Tuber
culosis and Lung Disease (IUATLD) to devote major sessions in its global con
ferences on "How to inform the general public that tuberculosis is still not under
control." This sort of public education is consistently being propagated by the
World Health Organization (WHO), which is also stressing the need for greater
governmental support.
The gravity of this situation is confounded by the fact that most of the new
cases of tuberculosis are with multiple-drug resistant tubercle bacilli, making the
available drugs useless. This is mostly due to noncompliance on the part of the
patients to take the full course of treatment. These "man-made" failures are ag
gravated by another "man-made" disease, the acquired immune deficiency syn
drome (AIDS). The combination of these two dangerous diseases is potentially
disastrous not only for certain areas of Africa as feared by Grange and Stanford
but will also affect the whole world if we do not act immediately. It is therefore
vital that concentrated efforts are urgently made to discover and develop new
drugs and treatment strategies to attack this disease. For this purpose, it is nec
essary to analyze critically the situation, not necessarily to rejoice at our past
glories of successful treatment, but more importantly to understand the "how"
and the "why" of the failures and to suggest realizable plans for the future.
In this volume, several aspects of chemotherapy are discussed extensively. Such
a comprehensive discussion which was contained in a treatise on the same subject
was edited by Vincent Barry more than 30 years ago. At that time, the potential
of chemotherapy to succeed was evident. The proper use of the powerful drugs
(excluding rifampin, which was not discovered at that time) and the proper ap
plication of the optimal regimens which were evolved following meticulously
conducted controlled trials were elaborated. Subsequently, much more progress
has been achieved, thanks to the discovery of rifampin and its use in short-course
chemotherapy, which is the mainstay of our present-day approach to the treatment
of tuberculosis.
In this volume, the authors have discussed the development of the basic and
experimental aspects of chemotherapy, our present-day philosophy of treatment
in the context of developed and developing countries, the lessons that were or
could have been drawn from the controlled clinical trials, and the reasons for the
failure of treatment. Management of patients with drug-resistant bacilli and with
nontuberculous mycobacterial infections and, more importantly, those with HIV
infection and with AIDS, are dealt with in other chapters. A chapter on the mag
nitude of the global impact of the present-day situation is given to introduce the
readers to the seriousness of the problem and two chapters on leprosy are included,
to impress upon the readers that success can be achieved even under difficult
situations and with a stubborn disease. This volume also contains a review on the
current approaches to discover newer drugs and strategies. It is sincerely hoped
Preface xi
that the diverse topics discussed in this and the companion volume will provoke
interest and encourage a spirit of enquiry in the reader.
Finally, the editors are extremely grateful to all the authors, but for them the
idea of a comprehensive treatise could not have been realized. The editors are
respectfully and apologetically aware of the enormous demands on their time and
effort our request should have made to the authors. We do realize how busy they
are in their own individual professional commitments. To each one of them we
offer our sincere thanks. We realize that timeliness is an important aspect, and
however much we and the concerned authors tried, considerable delays have oc
curred. To those authors who have been very kind to submit their manuscripts
early, we offer our apologies, but we have taken care to see that no discussion or
topic has become outdated. Overall, we are extremely gratified that these two
volumes offer an excellent compendium of the available knowledge on this dis
ease. We sincerely hope that the information these books provide will facilitate
prompt application of these thoughts for a successful crusade against this disease.
Let us prove that tuberculosis is, indeed, a curable disease.
Pattisapu R.J. Gangadharam
P.A. Jenkins