Sinethemba, 16, takes her daily regimen for XDR-TB at 10am each day. She also takes two additional delamanid tablets at night. Picture: Sydelle WIllow Smith
South Africa has become the first country in the world to replace an injectable drug with toxic side effects with a promising new oral medicine (bedaquiline) in the standard multidrug-resistant tuberculosis (MDR-TB) treatment regimens for adolescents and adults.
 
Doctors Without Borders (MSF) has welcomed the South African National Department of Health (NDoH)’s announcement and sees this as a positive step aimed at making MDR-TB treatment more tolerable, and reducing the devastating impact of side effects caused by the injectable agents.

In Khayelitsha, which has some of the country’s highest rates of DR-TB, MSF runs a strengthened regimen programme that incorporates new drugs into treatment regimens for DR-TB patients including Delamanid and Bedaquiline. Picture: Sydelle WIllow Smith 
“The standard treatment for MDR-TB is currently effective only 50% of the time, and includes a painful injectable antibiotic known to cause terrible toxic side effects, including kidney failure and hearing loss. Experience with bedaquiline in treating drug-resistant TB – mainly from South Africa - demonstrates improved clinical outcomes in people living with MDR-TB, and initial evidence shows that it can be safely and effectively used in place of the toxic injectable,” says MSF’s Dr. Anja Reuter, a DR-TB doctor in Khayelitsha in the Western Cape, where MSF has run a DR-TB programme since 2007.

 
Although there are still some hurdles in implementation, MSF has called on the government to support health facilities in developing capacity to use bedaquiline and other new drugs, and to manufacturers to reduce the prices they charge in South Africa and globally. Worldwide, more than half a million people are infected with MDR-TB every year but extremely few who could have benefited had access to newer TB drugs such as bedaquiline.

Simphiwe Zwide takes his first delamanid tablets, which have now been included into his treatment regimen for XDR-TB. Picture: Sydelle WIllow Smith 
MSF is urging other countries and officials responsible for WHO guidance on the use of DR-TB medicines to follow South Africa’s progressive example and commit to replacing the toxic injectable drug and ensuring expanded global access to effective new medicines, including bedaquiline.

* Doctors Without Borders/MSF is an independent international medical humanitarian organisation working to bring emergency medical care to people caught in conflict, crises and disasters in more than 65 countries around the world including South Africa.