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Developing Infectious Disease Strategies for the Developing World.

Paul J Lee1, Leonard R Krilov1

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This chapter reviews treatments for H5N1 avian influenza and multidrug-resistant tuberculosis (MDR-TB). Current H5N1 strains resist amantadine/rimantadine, while neuraminidase inhibitors may need higher doses. New quinolones show promise for MDR-TB.

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Area of Science:

  • Virology
  • Microbiology
  • Pharmacology

Background:

  • Human influenza A (H5N1) is an avian strain not well-adapted to humans.
  • H5N1 isolates exhibit resistance to M2 inhibitors like amantadine and rimantadine.
  • Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) requires novel therapeutic strategies.

Purpose of the Study:

  • To discuss current and emerging drug therapies for H5N1 influenza.
  • To review drug categories for treating MDR-TB, including quinolones, nitroimidazoles, and pyrroles.

Main Methods:

  • Review of existing literature on antiviral and anti-tuberculosis drugs.
  • Analysis of drug efficacy and resistance patterns for H5N1 and MDR-TB.

Main Results:

  • Amantadine and rimantadine are ineffective against H5N1.
  • Neuraminidase inhibitors (oseltamivir, zanamivir) show in vitro activity against H5N1, potentially requiring higher doses.
  • Methoxyfluoroquinolones like moxifloxacin are approved for other infections and gatifloxacin is in development for MDR-TB.

Conclusions:

  • Amantadine and rimantadine have no role in treating H5N1 avian influenza.
  • Oseltamivir and zanamivir are options for H5N1, but efficacy may be dose-dependent.
  • Quinolones represent a promising class of drugs for MDR-TB treatment.