Paper Sample on Tuberculosis: A Global Health Crisis

Introduction

The global prevalence of lung Tuberculosis remains one of the biggest concerns of international and national health organizations (Floyd et al., 2018). This infectious disease is caused by the Mycobacterium tuberculosis bacterial complex. TB may be spread from one human host to the next through an aerosolized form of the bacteria expressed in coughs of the infected individual. Risk factors for widespread community infections of the disease are thereby dependent on the duration of exposure to and infectiousness of the incident cases within the population. While only 5-15% of all the people infected with the bacteria globally develop the TB disease, research and medical practice have determined TB disease to possess the highest mortality rate among the infectious diseases (Floyd et al., 2018). This risk of mortality increased drastically when the TB patient had existing comorbidities such as HIV or malnutrition.

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As already stated above, and according to the world health organization (WHO), TB disease is currently the leading global cause of mortality of any infectious diseases (Macneil et al., 2019). The condition furthermore, contributes to approximately 40% of the total deaths of HIV-positive individuals globally. Since the year 2000, the world Health organization has continued to develop annual prevalence estimates for the disease in various global populations. Within that period, the condition has been noted in every country globally, with the highest prevalence rates coming from South-East Asia as well as Africa. During the first eighteen years of the 21st century, the number of new infections of the TB disease has stood continuously at just over 10million new cases annually (Macneil et al., 2019; Macneil et al., 2020). From the annual infections, the authors, as well as the global public health organizations, determine a consistent figure of 1.5million deaths globally each year. While these mortality figures indicate a sharp reduction since the mid-20th century, there is continued consensus that TB requires even better interventions through the next few years. From such a recognition of the need for more ambitious intervention practices for TB disease, the WHO has set strategic goals for reducing both the incidence of the disease and the global mortality rates. The world health organization has set the 2020-2035 window to stamp out the absolute cases and overall occurrences by up to 95% and 90%, respectively (Macneil et al., 2020). The disease prevalence rate in Africa and Southeast Asia, however, continues to present a challenge to the efforts to reduce the disease effectively. Macneil et al. (2020) report findings that suggest that Africa currently hold the highest number of people living with HIV and TB – 71% of all the reported case of people living with HIV and TB were said to be Africans. The highest overall number of TB infections was registered in Southeast Asia, with 44% of all global infections being reported from the region.

While the WHO continues to monitor and intervene in the new cases of TB disease annually, medical experts struggle with the reoccurrence of the TB cases among some individuals. Such reoccurrences of the disease create complicated medical conditions, including Rifampicin-resistance, as well as multi-drug resistance among the patients. In 2020, 4.8% of the people diagnosed with TB were observed to display strength to the known antibiotic TB medications (Macneil et al., 2020). Such cases of drug resistance were noted mainly among individuals with reoccurring TB cases (18%) in comparison to the first time cases (3.4). Nevertheless, the progress towards a TB-free future is underway and has stayed on the right track since the development of the strategic plan for TB reduction by the WHO in 2015. In 2018, the organization reported a 2% reduction in the incident cases of the disease globally, with a further 5% reduction in the mortality rate. These reductions represent an encouragement in the fight against the disease as they are in line with the projections made by the WHO.

Various intervention measures have continued to be employed by health experts in preventing and curing the disease (Macneil et al., 2020). Such actions range from Tuberculosis Prevention Therapy (TPT) to the antibiotic treatment. First, it is essential to note that TB disease is curable through antibiotic treatment regimens. The administration of such bacterial medications must, however, be done promptly as soon as the incident infection is noted. From the 2019 World Health Organization Tuberculosis report, up to 7million infected individuals in 2018 (70% of the total annual cases) received life-saving TB treatment (World Health Organization, 2020). This number represented a considerable rise in treated cases from 64% reported in 2017. However, overwhelming 3million individuals did not receive the required intervention. It is still highly encouraging to note that over 58million individuals were saved from TB-disease between 2000 and 2018.

The treatment regimens used in the cure of tuberculosis continue to display varying levels of safety and efficacy (Mitchison & Davies, 2009). Previously, most strains of the infection were treated by varying dosages of Rifamycin. The TB bacteria, however, have shown considerable resistance to this first-line of treatment. New anti-tuberculosis drugs have, thus, been introduced in curative interventions to replace the rifamycins. The most important new medicines for TB treatment include gatifloxacin and 8-methoxyfluoroquinolones moxifloxacin (Mitchison & Davies, 2009). The world health organization, however, observes that up to 377,000 new TB cases in 2018 were Multidrug-resistant TB (MDR-TB) cases (World Health Organization, 2020). Multidrug-resistant TB continues to present a new crisis in the global intervention to the TB pandemic. In this analysis, we focus on one of the novel treatment regimens and analyze the safety and efficacy of the regimen to the new and recurring TB cases. We thereby hypothesized that the long-term use of the 8-methoxyfluoroquinolones moxifloxacin and other fluoroquinolones present a high degree of success (efficacy) compared to the Rifamycin and Isoniazid antibiotics. Furthermore, we hypothesized that the moxifloxacin intervention is mostly safe to use against the Mycobacterium tuberculosis species.

Purpose of the Study

8-methoxyfluoroquinolones moxifloxacin continues to be analyzed variously in several medical publications as a preferred TB-treatment alternative over the rifamycin antibiotics (Codecasa et al., 2006; Mitchison & Davies, 2009; Naidoo et al., 2017; Thee et al., 2014). These different studies range from grounded approaches to empirically-based alternatives spanning a few years. This current study intends to gain a meta-analytic consensus on the safety levels of the various previous analyses. This study, as such, wants to analyze multiple studies on the safety and efficacy of moxifloxacin for long-term antibacterial use. The new treatment method will be examined on components ranging from the safety of use to the cases of Multidrug-resistant TB (MDR-TB). The purpose of the study is thus to uncover the united scientific resolution regarding the use of the moxifloxacin treatment regimen, especially in the long-term intervention approach to TB-treatment.

Objectives of the Study

To achieve the overall purpose of the study, the author will aim to investigate the following two objectives:

1. The safety levels of the moxifloxacin antibiotic in the long run treatment of TB.
2. The efficacy of the moxifloxacin treatment intervention on the TB disease, especially on the Multidrug-resistant TB (MDR-TB).

Methodology of the Study

The study employed a combination of a systematic review and a meta-analysis of scientific data around moxifloxacin TB treatment. The study thereby aimed at analyzing the available evidence around the topic and developing a scientific consensus. As such, the author did not require ethical approval for the study. The access to articles and scientific documentation did not require direct permission from the patients or hospitals from which the empirical data had initially been collected. The scientific databases used for this study included the renowned medical research databases, including PubMed Central (PMC), PubMed, EMBASE, and Google Scholar. To apply the current scientific evidence, the author opted to use the scientific articles from the past 15 years (since 2005) around anti-tuberculosis treatment, specifically the moxifloxacin treatment. Keyword search of such terms and phrases like “Moxifloxacin,” “tuberculosis treatment,” “Moxifloxacin treatment of tuberculosis,” and “efficacy and safety of Moxifloxacin,” “pulmonary tuberculosis,” and their synonyms were initially used for the analysis. To narrow down the search further, an entire topical search was conducted using the research topic “The Efficacy and Safety of Moxifloxacin for Tuberculosis in Long Term Use.” The selection criteria also required the articles to be peer-reviewed by at least two independent reviewers.

The keyword and topical search narrowed down the search from an initial 613 relevant articles to a final 24. After further analysis, seven (7) out of the 24 relevant studies were then selected for the final meta-analysis due to a combination of factors including their relevance to the safety and efficacy research on moxifloxacin that this present study focused on and their long-term use in the treatment among the patient groups. Data collection and the systematic review was then conducted with reference to the Cochran protocol (Higgins & James, 2019). Through the selection of the secondary data, the author thereby recognized the biases presented in the various studies in their empirical or theoretical research backings.

Results Analysis

In this results analysis section, the author will focus on a qualitative analysis of the eight selected articles to investigate the findings from each analysis. Furthermore, the author shall attempt to identify the thematic underpinnings that appear in multiple studies. Through the qualitative systemic review and meta-analytic methodologies, the author will find similar concepts around the safety and efficacy of the moxifloxacin in the treatment of tuberculosis. As such, the analysis of the results begins by outlining the key findings from each of the eight studies separately. Next, the report identifies the similar themes that exist among the findings and recommendations of the various studies. These themes are then aggregated and supported by further evidence in the discussion section of this research piece. The author uses tables to combine the critical thematic findings of the different analyses.

Key Findings from the Separate Studies

Study 1: Codecasa et al. (2006): Long-term moxifloxacin in complicated tuberculosis patients with adverse reactions or resistance to first-line drugs

This first study was conducted in the TB unit of a Regional reference center in Milan, Italy. Authors in this analysis aimed to determine the advance effects of prolonged exposure to moxifloxacin medication for TB. From this first study, the patients were enrolled based on their exposure to prolonged moxifloxacin treatment between January 2001 and 2003 at the Villa Marelli Institute. The TB unit in the regional reference center also acts as the national MDR TB care center. This unit, thereby, also contains the Drug Susceptibility Testing (DST) laboratory that helped in the anti-tuberculosis resistance anal...