Three-in-one drug wipes the floor with TB

A new drug combination is less toxic, quicker and cheaper than existing treatments, and seems to work against drug-resistant TB strains

After decades rampaging across the globe, tuberculosis has a real fight on its hands. That's thanks to the arrival of a drug combination that could for the first time dramatically shorten treatment and tackle both ordinary and multi-drug-resistant strains of TB.

Called PaMZ, the pill is a combination of the standard TB drug pyrazinamide with the antibiotic moxifloxacin ? not previously used against TB ? and PA-824, a drug whose potential against TB was reported by New Scientist in 2001.

PaMZ could wipe out several resistant strains of Mycobacterium tuberculosis ? the cause of most cases of TB ? which have been spreading through South Africa, India and the countries that made up the former Soviet Union. What's more, it could work in a sixth of the time of existing treatments, at a tenth of the cost ? as well as slashing by a third the number of pills required.

"We may have a major solution here," says Mario Raviglione, director of the World Health Organization's Stop TB campaign. The new treatment is "simpler, less toxic and much cheaper" than existing regimes, he says.

It also shows promise in treating TB in HIV-positive people, a real problem in sub-Saharan Africa.

PaMZ's potential emerged from a study in which various permutations of its three constituent drugs, plus one newcomer, bedaquiline, were tested on sputum samples from groups of people with TB in Cape Town, South Africa. PaMZ outperformed all other combinations, killing 99 per cent of TB bacteria within two weeks ? matching the four-drug treatment for ordinary TB.

In animal studies, PaMZ killed drug-resistant bacteria equally rapidly, and so could yield the first treatment lethal to both ordinary and resistant strains. It would also bring treatment time for resistant TB in line with ordinary TB. Andreas Diacon at the University of Stellenbosch in Cape Town, the studies' lead researcher hopes to begin a larger trial soon. "If that's successful, we may be able to roll the treatment out within four or five years," he says.

Journal reference: The Lancet, DOI: 10.1016/S0140-6736(12)61080-0.

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