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MDR-TB: We have such poor medical treatment to offer that we must resort to surgery!

Portrait of Dr. Dick Menzies
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How effective is surgery as adjunctive therapy for multi-drug resistant tuberculosis (MDR-TB)? This was the subject of a recently published study (PubMed, Jan 2016). About the importance of a combined therapy we asked co-author Dr. Dick Menzies from the Montreal Chest Institute at McGill University.

The authors of the study (Fox et al.) examined data on 6.431 patients who underwent pneumonectomy or partial lung resection, and compared their outcomes with patients who did not receive surgical treatment: It turned out that the treatment success was greater in surgical patients compared to nonsurgical patients.

But what is the background of this study? In the pre-antibiotic era, surgical procedures aiming to reduce bacterial load in diseased lungs were a mainstay of tuberculosis therapy. After the advent of effective medical therapies in the 1960s, surgical treatment of this disease was abandoned in many parts of the world: “As multi-drug resistant tuberculosis has re-created the conditions of the pre-antibiotic era, surgical resection for tuberculosis may have an important role in treating patients for whom medical therapy alone is likely to be inadequate”, says Menzies.

Incidentally, combined method does not mean that less antibiotics are used: “All patients who had surgery also had medical therapy with multiple antibiotics – in fact they actually took more therapy, not less”, Menzies explains. “The theory why combined treatment is working so well is that by debulking one removes a large number of highly resistant bacilli. The remainder are more easily cured with multi antibiotics, which are weak, but can treat some”, the physician continues.

The reason why surgical procedures to reduce bacterial load in diseased lungs were not executed for decades can be explained easily: “Tuberculosis is an infection that responds well to many antibiotics. Results are better with medical therapy than with surgery and much less expensive, less painful and less risky”, says Menzies. “But we have such poor medical treatment to offer that we must resort to surgery.”

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