New drugs against tuberculosis

The tuberculosis is in Germany only rarely. Worldwide the consumption is addiction but still a tölethal threat. New drugs should help

The Röntgen of the lung is an important investigation in suspected cases of Tuberculosis

The recording on the screen shows a lung. Somewhere in the upper area of bright light, delicate clouds in the Black-and-­Weiß-Grey Röntgenbildes. Dr. Ulrich Krämer is tapped with the Finger. "The da, the gehören da." Bright shadow, dark Fläor small weiße points, the betrayed lied to the Berlin radio, that it is tuberculosis (TB). 

The infectious disease is an old enemy. As Schwind.addiction or Wei&szlig…e plague gefüafraid of this, scooping up the people’s plague millions then – often in the Wake of Wars or Hungersnöth. Geschwäkilled AbwehrkräRTD make the outbreak of the feed. If left untreated, the Suffering can external Affected until it’s too töd­of the lungs or other Organschäendings.

Tuberculosis in Germany: Rare, but not disappeared

At the end of the 19th century. Century was the consumption of the zweithämost common cause of death in Germany. But even today medical get, such as here in Berlin, Helios-Klinikum Emil von Beh­ring to see tuberculosis patients. 5915 diseases registered by the Robert-Koch-­In­sti­does 2016 in Germany, in Berlin, there were 375. The are not many. According to the criteria of the Welt­gesundheits­organization we live in a "Low-Inzidenzland".

"Tuberculosis is a rare disease that well treat lässt", Professor Torsten Bauer, chief doctor of the Lungen&shy says;clinic. Here there is everything, what Ädoctors für the diagnosis and treatment need: a Röntgenabteilung and a modern laboratory, the pathogen to be demonstrated. The drugs für therapy. But Bauer also Generalsekretär of the German Central Committee for the Bekäcombating of tuberculosis, weiß, that not all problems gelöst: "Is not defeated tuberculosis, she was never entirely disappeared."

Even if it was temporarily forgotten. At the Station 52, housed in a separate ­Gebäude, hängen-Black-Weiß-Photos of the ­old heckeshorn lung clinic: children for rest cures, sisters with Häubchen, große Gebäbuilding and wooden barracks with hundreds of beds. The demand was in the Füfifties years groß. About 50 000 tuberculosis patients there were alone in Berlin.

The multi-drug resistant tuberculosis is a new challenge

Today läthe challenge of the sst of case numbers. Rather, pills boxes in the station room. As such, the nurses only distribute up to four different drugs. And patients whose daily dose of up to 20 tablets and a syringe.

Those who get only four tablets, the medication-sensitive Form of tuberculosis: The pathogen responds to a Cocktail of four different antibiotics. You bekänot fighting levels of the bacteria in a variety of development, in order to reproduce more köcan. "This is a Long-established therapy, which in most Fäcases relatively well wird&quot tolerated;, senior physician Dr. David Krieger says. 

The causative agent is, however, against the two most important drug-resistant, experts speak of a multi-drug-resistant tuberculosis, or MDR-TB. In Deutsch­country there are not many TB patients who are ill – approximately 2.7 percent. You will be treated in specialized centers such as Berlin, Helios-Klinikum, because the therapy means für patients and Ädoctors a challenge. "You have to be familiar with the side effects that drugs always re-adjust and the patients über for a long time motivieren", warrior says.

There are new drugs lacking

What in Germany is complicated, but doable l&auml, ;sst elsewhere hard &ndash realize; in Läcountries of the former Soviet Union, Parts of Asia or Africa, where more than a third of patients on MDR-TB suffers. "Since the sch&ouml helps you;an old standard therapy, unfortunately, is not mehr", Dr. Sebastian Dietrich says. He directs at "Ädoctors without Grenzen" in Berlin tuberculosis projects in Läcountries that are particularly affected.

The treatment lasts for up to two years and quäto lend, meets people there with großhe Härte: "The therapy, many are durch&quot very difficult to;, Dietrich says. What is missing are new drugs. But the pharmaceutical companies had set their research in the field as much as possible. The most important resources of today are, therefore, actually from yesterday: Pyrazinamide, Isoniazid, Ethambutol and Rifampicin are for half a century.

The pathogen is against you resistant, müshot the other drugs &ndash be used; because there are no Alternatives, even those which because of their side effects actually längst in the mothballs of the medicine were landed, as Dietrich says. Antibiotics, kidney or liver schäwalk-in köcan. Active ingredients, of the psychoses in some patients, depression or Schwerhöaffiliation hervor­call. Nevertheless, they are für the treatment is essential. .

Pretomanid is considered to be a new hope against MDR-tuberculosis

Only in 2014, the active ingredients &shy were;Delamanid and Bedaquiline für admitted to the TB treatment. "But two drugs are, unfortunately, a nicht", Dietrich says. New hope promises to PA-824, also Pretomanid. It schädamaged üabout the metabolism the genome of the bacterium. The rights to the Präthe Council of Europe, the TB Alliance, a kind of virtual and non-profit business-oriented Pharma bought a few years ago. The funds come from the Bill and Melinda Gates Foundation, the EU, the USA, and donations. Universitäth, pharmaceutical, and other research institutions are part of the network.

Pretomanid is the first drug in the TB Alliance for up to Zulassungs­studies has brought. "A külower level, simpler, and günstigere therapy of multi-drug resistant TB, the wäre in these Lächange is an important Ziel", Dr. Bern-Thomas Nyang&rsquo says;wa of "Ädoctors without Grenzen". He co-ordinated from London, the "TB-Practecal-Study", one of the größten patient studies with the not-yet-approved drug.

Also better medical care is nötig

The aid organization involved in the TB Alliance study, was a ungewöa similar step. It was schließno pharmaceutical companies, says Nyang’wa. "Unfortunately, there is no other such studies durchführt, therefore, we can make it now." 630 patients from Uzbekistan, WeißRussia and SüSouth Africa will participate. Part of it is treated for six months with a combination of the two new antibiotic, Bedaquiline, and Pretomanid and three already-proven drugs. A control group erhält previous therapy, the WHO recommends you.

Results will only be für 2021 expected; the experience so far, however, hope that the new treatment regimen will work köcould. It wäre a between goal. Händeringend also a new vaccine and Tests are sought to resistance faster to ­­recognize, for example in the case of children.

However, even such research achievements wüauthorities without better medical care, little nüsupport. Tuberculosis is üeverywhere in the world, the disease that shows how companies with the Schwäthe next deal, says Nyang’wa. "Since we still have ­a long way ahead of us."

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