Document Detail


From magic mountain to table mountain.
MedLine Citation:
PMID:  22915310     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Prior to the introduction of chemotherapy, tuberculosis management relied upon aerotherapy, heliotherapy and good nutrition. This "treatment", exemplified by the regimen applied in Swiss and other European mountain resorts, is described by Thomas Mann in the book "The Magic Mountain". Tuberculosis chemotherapy began in 1944 with the introduction of streptomycin and para-amino-salicylic acid, later augmented by isoniazid. Early experience taught physicians that treatment must be given with multiple drugs to prevent emergence of resistance and that prolonged treatment adherence for 18-24 months was needed for a permanent cure of tuberculosis. Between 1970 and 1980 rifampicin was introduced and with pyrazinamide it made "short-course" treatment possible. For 30 years, a 6-month directly observed treatment short-course (DOTS) based on the three compounds isoniazid, rifampicin and pyrazinamide was the foundation of tuberculosis control strategies world-wide, and in recent years this was supplemented with ethambutol in view of increasing rates of isoniazid resistance. However, even 6 months of treatment is too long to easily ensure the compliance necessary to permanently cure tuberculosis. The recent spread of the HIV/AIDS epidemic has placed tuberculosis programmes under severe pressure and is accompanied by an increase in drug-resistance making tuberculosis virtually untreatable in some instances. In 2004 the first of a new generation of anti-tuberculosis drugs entered clinical evaluation. A series of clinical trials, often conducted at sites in Cape Town, South Africa, has shown them to be efficacious and hold promise of being able to shorten tuberculosis treatment and treat drug-resistant tuberculosis. Development and assessment of these drugs is ongoing but there is renewed hope that these new drugs and regimens will assist in finally conquering tuberculosis, preventing a return to Magic Mountain where sunshine and fresh air was all that could be offered to patients.
Authors:
A Diacon; Groote-Bidlingmaier von; Pr Donald
Publication Detail:
Type:  Journal Article     Date:  2012-08-22
Journal Detail:
Title:  Swiss medical weekly     Volume:  142     ISSN:  1424-3997     ISO Abbreviation:  Swiss Med Wkly     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100970884     Medline TA:  Swiss Med Wkly     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  0     Citation Subset:  IM    
Affiliation:
Department of Biomedical Sciences, Stellenbosch University, Cape Town, SOUTH AFRICA; ahd@sun.ac.za.
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