When the first four patients with totally drug-resistant tuberculosis (TDR-TB) showed up at Hinduja hospital, they were resistant to all first-line and second-line drugs for tuberculosis. Further tests revealed that 3 of these patients had received erratic and unsupervised doses of second-line drugs from private practitioners to reverse multi-drug resistance.
The Government of India has a dedicated program to treat tuberculosis cases within the health system, known as the Revised National Tuberculosis Control Program (RNTCP). It relies on the Directly Observed Treatment Short Course (DOTS) strategy recommended by the World Health Organization (WHO) and provides free diagnosis and treatment. Under the program, a daily regimen of fixed-dose combinations of the three or four TB drugs must be taken under the direct supervision of a DOTS agent, usually a volunteer from the patient’s community.
However, multi-drug resistant cases do not have access to the same resources and usually fall through the cracks, relying instead on the unregulated private sector for care and treatment. One study found that only 5 of 106 private practitioners in Dharavi, Mumbai were able to provide a correct prescription for a hypothetical MDR-TB patient. Inappropriate and unregulated prescriptions have amplified resistance and contributed to the development of more dangerous strains of extensively drug-resistant tuberculosis (XDR-TB).
And yet, care and treatment for such patients have come a long way for a disease that has been recorded in Indian history for millennia.
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