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Tuberculosis treatment and management-an update on treatment regimens, trials, new drugs, and adjunct therapies.

WHO estimates that 9 million people developed active tuberculosis in 2013 and 1·5 million people died from it. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis continue to spread worldwide with an estimated 480 000 new cases in 2013.

Treatment success rates of MDR and XDR tuberculosis are still low and development of new, more effective tuberculosis drugs and adjunct therapies to improve treatment outcomes are urgently needed. Although standard therapy for drug-sensitive tuberculosis is highly effective, shorter, more effective treatment regimens are needed to reduce the burden of infectious cases.

We review the latest WHO guidelines and global recommendations for treatment and management of drug-sensitive and drug-resistant tuberculosis, and provide an update on new drug development, results of several phase 2 and phase 3 tuberculosis treatment trials, and other emerging adjunct therapeutic options for MDR and XDR tuberculosis. The use of fluoroquinolone-containing (moxifloxacin and gatifloxacin) regimens have failed to shorten duration of therapy, and the new tuberculosis drug pipeline is sparse.

Scale-up of existing interventions with increased investments into tuberculosis health services, development of new antituberculosis drugs, adjunct therapies and vaccines, coupled with visionary political leadership, are still our best chance to change the unacceptable status quo of the tuberculosis situation worldwide and the growing problem of drug-resistant tuberculosis.

Non-tuberculous mycobacteria in children: muddying the waters of tuberculosis diagnosis.

Non-tuberculous mycobacteria (NTM) are a large family of acid-fast bacteria, widespread in the environment. In children, NTM cause lymphadenitis, skin and soft tissue infections, and occasionally also lung disease and disseminated infections. These manifestations can be indistinguishable from tuberculosis on the basis of clinical and radiological findings and tuberculin skin testing.

A diagnostic and therapeutic problem for respiratory physicians and other clinicians is therefore evident, particularly in settings where childhood tuberculosis is common, and bacteriological confirmation of any mycobacterial disease is difficult because of low availability of laboratory services in low-resource settings and the inherent paucibacillary nature of mycobacterial disease in childhood.

The epidemiology of NTM varies by world region, and attempts to understand the burden of NTM disease and to identify risk factors in the paediatric population are hampered by inadequate mandatory NTM reporting and the overlap of clinical presentation with tuberculosis. The immune response to both NTM and Mycobacterium tuberculosis is based on cellular immunity and relies on the type-1 cytokine pathway. The disruption of this immune response by genetic or acquired mechanisms, such as mendelian susceptibility to mycobacterial disease or HIV, might result in predisposition to mycobacterial infections. Published diagnostic and management guidelines do not provide specific advice for diagnosis of NTM in children, from whom the quantity and quality of diagnostic samples are often suboptimum. Treatment of NTM infections is very different from the treatment of tuberculosis, depends on the strain and anatomical site of infection, and often involves antibiotic combinations, surgery, or both.

In this Review, we summarise the epidemiological and clinical features of NTM infection in children, with a specific focus on the implications for public health in settings with a high endemic burden of childhood tuberculosis.

Time Is Right for E-Cig Regulation (CME/CE)

(MedPage Today) -- No need for more studies, says former FDA official. (Source: MedPage Today Pulmonary)

Early Decline in Six-Minute Walk Distance from the Time of Diagnosis Predicts Clinical Worsening in Pulmonary Arterial Hypertension

Conclusions: Early declines in 6MWD (within the first 6 months) predict future clinical worsening of PAH with high specificity. #x0394;6MWD may still be part of a comprehensive assessment of a patient's clinical status. However, given the poor sensitivity, a decline in 6MWD should be used with other clinical tools to make an appropriate assessment of the progression of PAH.Respiration (Source: Respiration)

Antibiotic nanoparticles attack respiratory infection at source, reduce drug side effects

Treating respiratory disease is often difficult because drugs have to cross biological barriers such as respiratory tissue and mucosa, and must therefore be given in large quantities in order for an effective amount to reach the target. Now researchers have shown that the use of nanoparticles to carry antibiotics across biological barriers can be effective in treating lung infections. Doing so allows better delivery of the drug to the site of infection, and hence prevents the development of antibiotic resistance which may be caused by too large and continued doses of antibiotic. Additionally, such a strategy might help to overcome the rapid metabolism and excretion of the antibiotic from the body, which happens when it is administered by traditional routes, either orally or intravenously. ...

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