Breathing uneasy over TB
Tuberculosis is a disease of antiquity that claims nearly 1,000 lives every day in India. There are serious challenges that continue to exist in the TB landscape. One of these is drug resistance to anti-TB drugs. Though drug resistant TB has been in existence for long, it has lethal forms that continue to emerge and threaten to undermine the extensive work undertaken to prevent and control the spread of TB.
Drug resistant TB is a man-made problem, the result of treatment mismanagement due to which the TB bacteria develops resistance to the two or more most commonly used drugs in the current four-drug (or first-line) regimen, leading to multidrug-resistant TB (MDR-TB). In some cases, this mismanagement can transform itself into extensively drug resistant TB (XDR TB), where the bacteria do not respond to even second line drugs. This poses a serious threat to global TB control. To make matters worse, an advanced form of drug resistance has been reported recently in India. It is known as extremely drug resistant TB (XXDR-TB). In this form of the disease, none of the known TB drugs or their combinations work.
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MDR-TB can only be treated with second line drugs which are very expensive. The treatment course is very long and expensive. It is vital to have mechanisms of appropriate regimen and ensuring access to quality assured drugs. Self-prescription of anti-TB drugs promotes drug resistance. This is made worse by the lack of regulation in accessing these drugs. Treatment of MDR TB commences after detection, a process that takes many months when conventional methods are used. As a result, patients with MDR- or XDR TB continue to spread the infection to others. Drugs used to treat MDR- and XDR TB are toxic and expensive when compared to those used in the treatment of basic TB. While a course of standard TB drugs costs approximately Rs.1,000, MDR-TB drugs can cost more than Rs.100,000. XDR-TB treatment is far more expensive. The need of the hour is not only detecting drug resistant strains early, but also initiating measures for optimising disease management and care so that each patient is diagnosed quickly and treated appropriately.
http://www.thehindu.com/opinion/op-ed/article3606725.ece
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