NEW YORK -- Health officials are being hampered in their fight against tuberculosis because pharmaceutical companies have stopped producing two of the most effective drugs, the New York City Health Department said Tuesday.
The department said the drugs, used to fight strains of tuberculosis that are resistant to other medications, were taken off the market because they were not profitable. But one manufacturer said its product was discontinued because a vital ingredient is not available.
Dr. Margaret A. Hamburg, the city's acting health commissioner, said pharmaceutical companies have an "ethical obligation" to make the drugs available and to develop new ones.
She also released a study showing an ominous rise in cases of drug-resistant TB, which is more difficult and costly to treat and which was responsible for the deaths of 13 prison inmates and one guard during the past year in the New York State prison system.
The two drugs identified by Dr. Hamburg are streptomycin and para-aminosalicylic acid, or PAS, which is one of the first anti-TB
Tony Biesada, a spokesman for Pfizer Inc., which manufactured streptomycin, said that earlier this year the Food and Drug Administration banned the import of its main ingredient because the French plant that produces it did not meet American standards. Another manufacturer could not be found, he said.
"We're willing to do whatever is necessary to make it available again," he said. Talks are under way with the FDA and the supplier, he said.
Dr. Thomas R. Frieden, a New York-based epidemiologist who works for the Federal Centers for Disease Control in Atlanta, described streptomycin as "fundamental" to treating tuberculosis."
PAS, in contrast, is used rarely, and mostly in patients whose disease is resistant to nearly every other drug. The number of patients with highly stubborn strains of tuberculosis is increasing, Dr. Frieden said, and PAS may be needed more often.
The maker of PAS, which a health department spokeswoman, Margaret L. Karanjai, identified as the Lanett Co. of Philadelphia, could not be reached for comment.
Figures compiled by Frieden show of all TB patients diagnosed in April, more than one-third had resistance to one or more TB medications. Nearly one in five patients was resistant to the most widely used drugs, Isoniazid and Rifampin, and that fraction more than doubled since 1982.