Mumbai hospital reports first set of ‘total’ drug-resistant TB cases


Almost three years after the first set of patients were diagnosed with Totally Drug-Resistant Tuberculosis (TDR-TB) in Iran, researchers at the P D Hinduja National Hospital and Medical Research Centre here said today they have detected India's first set of TDR-TB patients — 12 over the past two months.

In a paper published in the international journal Clinical Infection Diseases, Zarir Udwadia and his team have described how they detected the first four TDR-TB patients.

"Prior to TDR, XDR or extensively drug-resistant TB was the furthest stage patients had been diagnosed with in India. After drug susceptibility testing was performed on four TB patients present at the hospital, it was seen that all four patients were resistant to both first line as well as second line treatment," said Udwadia, adding that there was no treatment for them.

According to Udwadia, the drug-resistant nature of the TB-causing mycobacterium tuberculosis increases with mutations of the strain often catalysed by incorrect and erratic administration of second-line drugs. "An audit of the patients' prescriptions showed that three of the first four patients received unsupervised second-line drugs often in incorrect dosages by private practitioners in an attempt to treat their multi-drug resistant TB (MDR-TB). By the time they were referred to us, they had moved from the MDR stage and the XDR stage to TDR-TB," he said.

In a study a few years ago, it was seen that only five of 106 private practitioners in Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and amplified resistance, converting MDR-TB to XDR-TB and finally TDR-TB.

WHO estimates that India accounts for 20% of the world's total load of MDR-TB.

"The Revised National TB Control program (RNTCP) might have been a success but only a very small percentage of MDR patients actually have access to Directly Observed Treatment Short-course (DOTS, the globally standardised short-course chemotherapy cure for TB). It's probably time we rethink our TB control policies" said Udwadia.

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