**11. MDR/XDR-TB treatment-pipeline agents or compounds in clinical trials and related innovative researches**

Currently, drugs in phase III clinical trials are moxifloxacin, gatifloxacin, and meropenem [72]. Heteronemin, nephalsterol, litosterol, and kahalalides are other interesting compounds which are in pre-clinical stage [72]. Okada M *et al*. conducted a study on granulysin and a new DNA vaccine against MDR/XDR-TB and revealed that agglutinating virus of Japan/Heat-Shock-Protein65DNA+Interleukin-12-12DNA vaccine provided strong therapeutic efficacy in killing MDR/XDR-TB bacilli in mice and monkey models [73]. A recent experiment using MDR-TB monkey models which received normal and genetically altered Bacilli Calmette Gue′rin (BCG) vaccines demonstrated that these 2 groups of monkeys survived well compared to the control group [74]. Another study in XDR-TB mice model showed ability of interleukin-7 to kill the bacilli [74].

with DST of several anti-TB agents, the lack of standardized DST methods for several present and new investigational drugs, and insufficient evidence to link such DST results to patients' treatment outcomes [78]. No DST methods for group 5 and new investigational agents currently exist [78]. Molecular DST for the second-line drugs cannot yet replace phenotypic methods [78]. Collaboration between the national TB control programme, Ministries of Public Health, and the pharmaceutical companies will be required to resolve the limitations of treatment options by the compassionate use of new anti-TB agents [78]. The WHO will be the lead in ensuring that better patient data provide a more robust

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As countries are purchasing and using second-line drugs, the likelihood of misuse and developing of TB-resistant strains increases. Currently, WHO and its partners have reached the phase of expanding MDR-TB control as a component of a comprehensive TB control programme. Launching in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) expected that requests for second-line drugs for MDR-TB management should go through the Green Light Committee to prevent their misuse. The number of Green Light Committee-approved MDR-TB control programme is increasing rapidly as a result of main streaming of MDR-TB management into general TB control efforts. Expanding projects and accelerating evidence gathering are essential to further develop international policies. The TBendemic countries themselves and the ability of the technical agencies, as well as the donor

community are the factors of future success to expand MDR-TB control programmes.

10th Zonal Tuberculosis and Chest Disease Centre, Chiang Mai, 10th Office of Disease Pre‐ vention and Control, Chiang Mai, Department of Disease Control, Ministry of Public Health,

[1] The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. Anti-tuberculosis drug resistance in the world 1999-2002. Third Global Report.

Communicable Diseases. Geneva : World Health Organization ; 2003.

information for future policy decision [78].

**13. Conclusion**

**Author details**

Thailand, Thailand

**References**

Attapon Cheepsattayakorn\*

Address all correspondence to: attaponche@yahoo.com
