Precision medicine for drug-resistant tuberculosis in high-burden countries: is individualised treatment desirable and feasible?

Helen Cox, Jennifer Hughes, John Black, Mark P. Nicol

Research output: Contribution to journalReview article

18 Citations (Scopus)

Abstract

Treatment for drug-resistant tuberculosis is largely delivered through standardised, empirical combination regimens in low-resource, high-burden settings. However, individualised treatment, guided by detailed drug susceptibility testing, probably results in improved individual outcomes and is the standard of care in well-resourced settings. Driven by the urgent need to scale up treatment provision, new tuberculosis drugs, incorporated into standardised regimens, are being tested. Although standardised regimens are expected to improve access to treatment in high-burden settings, they are also likely to contribute to the emergence of resistance, even with good clinical management. We argue that a balance is required between the need to improve treatment access and the imperative to minimise resistance amplification and provide the highest standard of care, through a precision medicine approach. In tuberculosis, as in other diseases, we should aim to reduce the entrenched inequalities that manifest as different standards of care in different settings.

Original languageEnglish
Pages (from-to)e282-e287
JournalThe Lancet Infectious Diseases
Volume18
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018
Externally publishedYes

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