TODAY -

Inhaled drug therapy for TB treatment

Alice Tembe *

Inhaled drug therapy for TB treatment



In the light of the outcry of the high pill burden, severe toxicity and high treatment non-adherence rates, and many more challenges associated with the treatment of TB, in particular of multidrug-resistant tuberculosis (MDR-TB), innovative drug therapies are beginning to be explored. One of them - inhaled TB drugs - were presented at the 46th Union World Conference on Lung Health held recently in Cape Town.

Professor Anthony Hickey, a Senior Research Pharmacologist at RTI International Research Triangle Park, was of the opinion that inhaled drug therapy for TB should not be approached with any fear and the duration to get it to commercial production should not be too long, considering that it is not, and will not, be an entirely new and blind search for effective options.

There is a history of inhalation therapy in the late 1940s when the streptomycin drug started showing signs of resistance. The inhalation therapy was however abandoned only to resurface in the 1980s in trials for HIV drugs until 2010 when tobramyanin was rolled out. But then, after this, it seems the trail died again,even though there were indications of effective responses. Needless to say, there is already a model to follow for researchers, as outlined by this history on inhaled therapies, from the stages of formulation of the drug, dosage development, device development for administration, and the steps towards product approval. These were the sentiments shared by Professor Anthony Hickey.

The rationale

It has been noted already that oral or injectable drug therapy are probably the cheaper way to administer TB drugs. However, it is also evident that these approaches have not been the most favorite among patients and even health care professionals. Inhalation therapies may actually be more expensive to take to the ordinary person but as shared by Dr Stefano Giovagnoli, Assistant Professor in Pharmaceutical Sciences at the University of Perugia, Italy, there are great health benefits that the inhaled therapy brings.

Firstly, for lung delivery there can be cellular targeting in high concentration of TB bacilli. This may possibly rapidly reduce transmission of the TB bacilli due to high airway concentration of drug delivery. Secondly, there will be lower systemic exposure, thus minimizing side effects, especially like damage to the liver, since the drugs will be administered directly to the lungs. Thirdly, inhaled dosages can be easily manipulated to be lower or higher as needed. This means that dosage can be easily adjusted in case of children and adults, as well as for prophylactic doses. Lastly, there can be systemic onset of action, thereby accelerating high surface area for absorption.

The advantages of inhaled drug therapy could be endless. It would accentuate other health benefits and long term research and management of TB. Unlike injections, inhalers are non-invasive and also eliminate needle based risks of cross infection, especially for patients with HIV and hepatitis; and eliminate the pain associated with injectables for MDR-TB treatment, especially in underweight adults and children.

This will also open up opportunities to reduce the duration of treatment in both drug susceptible and drug resistant TB. It is also likely to result in better treatment compliance versus injectables and/or oral therapy.

Inhalers are easy to store and transport without refrigeration. They are easier to administer as compared to injections and thereby reduce the work burden on the resource strapped and understaffed health delivery systems. This would be especially advantageous in high burden and resource limited settings. Lastly and most importantly, the inhalation therapy has the potential to use existing treatment regimens that are already approved by the WHO to have anti-mycobacterial activity, but which cannot be given systematically due to high toxicity.

In perspective

Professor Bernard Fourie, Professor in Medical Microbiology at the University of Pretoria, with the help of others, has already initiated consultations with the parties that will engage with the end product. He shared that in establishing whether health care staff and patients are ready for inhaled anti-TB drugs, over 92% of patients noted that they would be comfortable using an inhaler and 84% found it easy to use, with indications that it will help in administration of medication in elderly patients too.

Although there are no major foreseeable barriers (medical or cultural) to this product adoption, 22% respondents did voice concerns about durability in repeated use of the inhaler and 26% queried about the safety and hygiene of the procedure.however, let us not forget that patients with asthma have used inhalers for a very long time now and certainly with the similarities, lessons can be drawn to ensure safety and hygiene in case of anti TB inhalers.

Areas to consider in the inhaled drug therapy for TB would be:

- Prophylactic inhalers for high risk populations, including persons working in active TB hot spots, for treatment of latent TB rather than wait for active TB development. Low dosage drugs introduced in the airway may target quick absorption and minimal toxicity.

- Investigation of lung toxicity and airway sensitivity as a conduit for potentially toxic and high dose TB drugs.

- Positive impact of the therapy on the high rate of comorbidities that TB has and its linkages with other conditions like HIV, diabetes, smoking, etc. Already, these conditions have some drugs that adversely interact with TB drugs and if not, they add to the toxicity and pill burden.

- Inter-tracheal administration of TB medication may only offer protection for pulmonary TB and not extra-pulmonary TB.

Smart phones have eliminated the need for calculators, physical fitness gadgets, mobile radio, computers, camera, scanner, voice recorder and even currency converter machines. If we could harness the human development advancement in technology, we could advance a step further in case of TB treatment by exploring the use of inhaled therapies and stop the TB epidemic in our generation. The journey will be worth it. As Charles Darwin had noted, "it is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change".


* Alice Tembe, CNS Special Correspondent, Swaziland, wrote this article for e-pao.net
The article is forwarded by Bobby Ramakant - CNS who can be reached at ramakantbobby(aT)gmail(doT)com
This article was posted on December 16, 2015.


* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • Addressing the Zeliangrong question
  • COVID-19 Status 10 August: Govt of Manipur
  • Ramkashing, Sinneihoi, Aton: eMing
  • Naga Peace Process :: News Timeline
  • Women plug food supply gap during lockdown
  • NGO Studies (MAINS) program in South Korea
  • Initiate inquiry for Hospital refusal
  • Love in the Hard Times :: Poem
  • From cluster to local transmission
  • Negative remarks on positive activities
  • MK PB Singh, 1st CM & Mizo agitation
  • COVID-19 Status 9 August: Govt of Manipur
  • Azolla: An organic farmer's friend
  • Corona Came Calling... :: Poem
  • Manipur gi sakkhangbidraba yelhoumee
  • COVID-19 : Impact in Manipur :: News Timeline
  • Thousand questions to life but.. one answer
  • Time to take all into confidence
  • Yaoshang Thabal Chongba #2 : Gallery
  • COVID-19 Status 8 August: Govt of Manipur
  • Impact of Covid-19 on mobile phone users
  • International Day of Indigenous Peoples
  • A call against systematic inequalities
  • August Diary :: Poem
  • A tale of Friendships Unlocked !
  • A Nuclear Free Future
  • Stay positive on Northeast plan
  • Is MSPDCL taking advantage of COVID-19
  • Folk Dance @Republic Day #2 : Gallery
  • COVID-19 Status 7 August: Govt of Manipur
  • Written obituary :: Poem
  • Truth unearth by COVID-19 pandemic
  • Clarification from SKY Hospital
  • COVID-19: Orders - 7 Aug: Govt of Manipur
  • Children's psychology & lockdown intervention
  • No confidence & godfather
  • Death in childbirth in the 21st century !
  • Need for a suitable pandemic model
  • Phuba Khuman in Senapati dist #1 : Gallery
  • COVID-19 Status 6 August: Govt of Manipur
  • Thoubalphobia- Malemnganbi's Child Delivery
  • Why not establish veterinary college, Manipur
  • India-Myanmar Convergence :: Webinar
  • National Education Policy : A New Horizon
  • Wanted : Total figure of local transmission
  • Lets appreciates the thousands heroes
  • Become an Amateur Astronomer
  • COVID-19 Status 5 August: Govt of Manipur
  • BIG 17th call : Biotech Ignition Grant
  • Maya Kuki- 3 titles at IAWA India 2020
  • 2020 :: Poem
  • What is Intellectual Property Right (IPR)?
  • Art of running a coalition Govt
  • Traditional Raas Dance #3 : Gallery
  • COVID-19 Status 4 August: Govt of Manipur
  • 2 from Manipur clear Civil Services Exam
  • Education Policy: Prospects & Way Forward
  • Appeal to stop Chromite mining
  • Agri-enterprises for Atmanirbhar North-East
  • Changes to make-up during COVID-19
  • Time to act sensibly
  • Barricading or brainstorming?
  • Tarao Laimanai, Chandel #2 : Gallery
  • COVID-19 Status 3 August: Govt of Manipur
  • Ravi's take on China factor in NE Insurgency
  • Opportunities in post COVID days
  • Shifting of drug supply trend in Manipur
  • Hope in COVID Era !! :: Poem
  • Press Communique from NPF [3 Aug]
  • Stand on ST demand
  • Culturals @ Sangai Fest 2019 #3 : Gallery
  • COVID-19 Status 2 August: Govt of Manipur
  • Misinterpretation of Naga Political Settlement
  • Home returnees, unemployment & ILPS
  • NEP to adversely affect future of North-east
  • Conflicts of laws on Child Marriage & POSCO
  • His Stoic Endurance :: Poem
  • 'Declare relatives working in Naga movement'
  • Rise from July 1 to August 1
  • 'Zehara' - Manipuri Movie :: eRang Classic
  • COVID-19 Status 1 August: Govt of Manipur
  • CCC @ Khongnangkhong [Aug 1]: Gallery
  • Where are the men in family planning ?
  • Asymptomatic & Rapid Antigen Testing
  • Cosmic Lover :: Poem
  • Incremental benefit of cleaning Nambul River
  • Why only 5 Kg of rice to cardholders?
  • Imphal View from Nongmai Ching #1 : Gallery
  • COVID-19 Status 31 July : Govt of Manipur
  • Id-Ul-Azha celebrated by Meitei Pangal
  • COVID-19 & its detection strategy
  • Physical Education & Sports @ MU
  • Naming the COVID vaccine
  • Withdraw MoUs signed for mining
  • More deaths, more concern
  • Ailing Nambul River recovering
  • Dr TS Gangte: Pioneer of higher education
  • COVID-19 Status 30 July : Govt of Manipur
  • August Calendar for Year 2020 : Tools
  • Hand sanitizer @Kakching [Jul 29]: Gallery
  • The Killing Fields 2013-20 : News Timeline
  • Orders / Memo on 30 July : Govt of Manipur
  • National Education Policy 2020
  • A Golden Jubilee Reunion :: Poem
  • Employment options in Insurance Industry
  • The Political life of the State
  • Recording death tally at four
  • Hentak :: An indigenous Manipuri food
  • COVID-19 Status 29 July : Govt of Manipur
  • Enforcement of COVID-19 Guidelines
  • My Love :: Poem
  • LPG management and supply
  • International Faculty Development Program
  • High-end Forensic Geology in crime scenes
  • Covid-19: Impact in Manipur :: Photos/News..
  • Manipur on the map of COVID death
  • Checking corruption: greatest joke of the year
  • Imphal during lockdown [26 July] #2 : Gallery
  • COVID-19 Status 28 July : Govt of Manipur
  • Plantation is no less a serious business
  • COVID-19 : Impact on mobility of women
  • Appeal to stop Mining in Ukhrul, Kamjong..
  • Making sense of lockdown
  • Non-Discrimination in combating COVID-19
  • Zeiladjang @ Makuai, Tamenglong : Gallery
  • COVID-19 Status 27 July : Govt of Manipur
  • Chassad & the Question of Justice
  • Online Training program for Police Officer
  • Proposal of Online Education: Its impact
  • The walls of Roman Londinium
  • Reminiscence of coming :: Book Review
  • Seeking to set house in order
  • The dawn of a new-normalcy
  • Imphal during lockdown [26 July] #1 : Gallery
  • COVID-19 Status 26 July : Govt of Manipur
  • Delimitation amasung yelhoumee Meetei..
  • Investigative Journalism training conducted
  • Gas Balloons :: Poem
  • Career in insurance: Jobs for millions
  • Meet model teacher helping students
  • Understanding total figure of 2212
  • Manipur Art Fest 2019 #1 : Gallery
  • COVID-19 Status 25 July : Govt of Manipur
  • PM calls for Vocal for Local to Manipur
  • Makhol_ Discussing Arts E2 with Astad Deboo
  • Society :: Poem
  • IQs & EQs of politicians
  • Living with COVID 19
  • 'Blood donors should be welcome'
  • Bracing for the worst
  • Princess & Political Agent launch #2 : Gallery
  • COVID-19 Status 24 July : Govt of Manipur
  • Virus Fabrics Spray by Kakchingtambam Kiran
  • Tales from a conflict zone :: Poem
  • Why Manipur senior IPS officer shot himself
  • Anti Defection Law: Big Debate
  • COVID-19 vaccine : So near and yet so far
  • Central observers here after trip to Delhi
  • The limitation on Free Speech
  • Impact of COVID-19 on transgender
  • COVID-19 Status 23 July : Govt of Manipur
  • Love Story of Tonu Laijing Lembi
  • 29th NAMA Virtual Convention 2020
  • Understanding disasters & disaster mgmt #2
  • Seeking NHRC to intervent in Akhil Gogoi case
  • Impacts of COVID-19 on agriculture : Paper
  • Lockdown & opening doors to outsiders
  • In search of the elusive leader
  • Anti-Repression Day #2 : Gallery
  • COVID-19 Status 22 July : Govt of Manipur
  • Race Apart ? :: Poem
  • Of political instability, COVID & war on drug
  • Preventing skin damage due to face masks
  • Issues raised by NPF Legislature Wing
  • Webninar : How to develop skills in writings
  • Nonsensical rush for fuel
  • When the virus starts attacking
  • Manipur & the Lushai Expedition, 1871-72 #3
  • COVID-19 Status 21 July : Govt of Manipur
  • Negatives turning positive, catastrophe in wait?
  • Environmental change : Uttarakhand : Rvw
  • Empathy Campaign at Imphal Airport
  • Rejoinder by Dr. Liezietsu [21 Jul]
  • Responsible conduct- Jiribam to Thoubal
  • BJP may be in trouble..
  • The Princess & Political Agent launch : Gallery
  • COVID-19 Status 20 July : Govt of Manipur
  • Governor & Maharani launch Binodini's Book
  • Mount Koubru: Its dying glory, & way forward
  • Govt expenditures on education in Manipur
  • 2nd Online Career counseling in IT
  • The last of the oaks :: Poem
  • Rising cases of infection
  • Manipur today is living on mercy of Delhi
  • HSE Toppers - Commerce stream : Gallery
  • COVID-19 Status 19 July : Govt of Manipur
  • Featured Front Page Photo 2020 #3: Gallery
  • Loktak Lake: A gem perishing front of our eye
  • Man behind 'Save Nambul'
  • X-rays and applications
  • COVID-19 pandemic & existential crisis
  • Training programme on mushroom cultivation
  • Best result in last three years
  • HSE Toppers - Science stream : Gallery
  • COVID-19 Status 18 July : Govt of Manipur
  • Understanding disasters & disaster mgmt #1
  • Salam Sangita : NE Women Success Stories
  • Subconscious Mind in COVID Era :: Poem
  • In quest of leadership
  • 4 BJP Ministers' visit to Delhi
  • HSE Toppers - Arts stream : Gallery
  • COVID-19 Status 17 July : Govt of Manipur
  • Between hospitals and hope
  • War on drugs: A losing battle in Manipur
  • Rays of the Setting Sun :: Poem
  • What actually LOP meant & intended : NPF
  • Rejoinder by Dr. Shurhozelie Liezietsu
  • Posers over Delhi trip
  • The face of justice
  • Class XII Result : Highest Marks
  • Class XII Result : Science Toppers
  • Class XII Result : Arts Toppers
  • Class XII Result : Commerce Toppers
  • Class XII Result : District PC
  • Class XII Result : Science
  • Class XII Result : Arts
  • Class XII Result : Commerce
  • COVID-19 Status 16 July : Govt of Manipur
  • Training programme on mushroom : Gallery
  • Diplomacy in Power & Leadership
  • PPE distributed to Community Health Centre
  • Think population studies as career
  • Intensify agitations as Govt fails to act
  • The Jiribam and Thoubal experience
  • Discovery of Thangjing hill range waterfall
  • Anti-Repression Day #1 : Gallery
  • Accelerating rights of women, post-COVID
  • Heritage Park @ Sangai Festival : Gallery
  • EEVFAM Foundation day : Gallery
  • Mining MoUs & Concerns in Manipur
  • Licypriya low-cost 'Face Shields' : Gallery
  • Airlifting of organic Pineapples : Gallery
  • 9th Manipuri Film Awards (MANIFA) Result
  • Yaoshang Halankar @BijoyGovinda #2: Gallery
  • Manipur & the Lushai Expedition, 1871-72 #2
  • Barak waterfall @ Tamenglong #2 : Gallery
  • Kanglen Aarti katpa #2 : Gallery
  • Eikhoigi Puwarini Nambul Turel #2 : Gallery
  • Manipur & the Lushai Expedition, 1871-72 #1
  • Takhelchangbam Kunjabihari : Wari Liba
  • I Rise :: Film Scenes : eRang
  • Class X (HSLC) Exam Toppers : Gallery
  • Class X Exam 2020 : Merit List
  • Class X Exam 2020 : Result Sheet
  • Class X Exam 2020 : Subject Toppers
  • Class X Exam 2020 : Statistics Abstract
  • Motsillaba Mingsel :: eRang Photos
  • Eyek Tamba :: Learn Manipuri script
  • SPONSORED ADS