ARTICLE: Potential of Pan-Tuberculosis Treatment to Drive Emergence of Novel Resistance
AUTHORS: C Finn McQuaid, Theresa S Ryckman, Nicolas A Menzies, Richard G White, Ted Cohen, Emily A Kendall
JOURNAL: Emerg Infect Dis. 2024 Aug;30(8):1571-1579. doi: 10.3201/eid3008.240541.
Abstract
New tuberculosis (TB) drugs with little existing antimicrobial resistance enable a pan-TB treatment regimen, intended for universal use without prior drug-susceptibility testing. However, widespread use of such a regimen could contribute to an increasing prevalence of antimicrobial resistance, potentially rendering the pan-TB regimen ineffective or driving clinically problematic patterns of resistance. We developed a model of multiple sequential TB patient cohorts to compare treatment outcomes between continued use of current standards of care (guided by rifampin-susceptibility testing) and a hypothetical pan-TB approach. A pan-TB regimen that met current target profiles was likely to initially outperform the standard of care; however, a rising prevalence of transmitted resistance to component drugs could make underperformance likely among subsequent cohorts. Although the pan-TB approach led to an increased prevalence of resistance to novel drugs, it was unlikely to cause accumulation of concurrent resistance to novel drugs and current first-line drugs.
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