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HindustanTimes Thu,28 Aug 2014

New worries over drug-resistant TB

Prachi Pinglay and Menaka Rao, Hindustan Times  Mumbai, January 30, 2012
First Published: 01:07 IST(30/1/2012) | Last Updated: 01:09 IST(30/1/2012)

Prakash Kadam, 15, a Class 8 student, complained of persistent cough and fever for about three months.

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Two weeks ago, when the Vashi resident was tested for tuberculosis, he tested positive for multi-drug-resistant tuberculosis (MDR-TB) and was admitted to the Sewree TB Hospital.

This was the first time that Kadam had contracted TB. “Initially, a private doctor treated him for a cough and fever. Then the doctor asked us to take him to the TB hospital. He is still very weak,” said Kadam’s father, Krishna, who works as a daily wage labourer in Navi Mumbai.

MDR-TB is TB that is resistant to at least two of the most effective anti-TB drugs prescribed in the first line of treatment. This is usually a result of non-completion of the treatment or because of wrong medication prescribed by doctors who are not qualified.

Although these figures are not approved by the Government of India, the 2011 World Health Organisation (WHO) report on TB states that an estimated 32% of the MDR-TB patients in India were infected with the MDR-TB directly. Estimated government figures for Maharashtra show that only 5% of the total new cases had MDR-TB.

Doctors agreed that patients suffering from the disease could spread the MDR-TB infection. “Nowadays MDR-TB patients are spreading bacteria, which are drug resistant. It is one of the reasons why such cases are rising,” said Dr Ashok Mahashur, consultant chest physician at Hinduja Hospital, adding that 15% to 20% of MDR-TB cases contract the drug-resistant bacteria directly.

However, Dr SK Jindal, chairman, Directly Observed Treatment Shortcourse (DOTS) plus programme, said the possibility of a patient contracting MDR-TB from another patient was very low “MDR-TB can be caused by the mutant strain of bacteria. But the bacteria is not very effective in infecting others,” Jindal said.

Geeta Joshi, 33, first contracted TB in January 2010, but the Andheri resident reduced her medicines when she started feeling better. She then contracted MDR-TB in December and was admitted to the Sewree TB Hospital last month.

“MDR is a man-made disease, caused by default in treatment,” said Sandeep Ahuja from the Stop TB Partnership, a non-profit working for eradication of TB along with WHO. “While the government estimates that 7% TB patients do not complete their treatment, our experience is that it could be as high as 30%.”

Faulty prescriptions are another concern. “Faulty dosage and combination of drugs prescribed by unqualified doctors or quacks adds to drug resistance,” said Mahashur.

In 2010, a study by Hinduja Hospital with private medical practitioners in Dharavi showed that only five out of the 106 doctors could prescribe the correct prescription for a hypothetical MDR-TB patient. Faulty prescriptions can amplify resistance to cause extensively drug-resistant TB (XDR-TB) or extremely drug-resistant TB (XXDR-TB).

The infection is also spreading among children. A study conducted at BJ Wadia Hospital for Children at Parel revealed that 34 of the 500 child TB patients aged between six months and 15 years, treated at the hospital between 2007 and 2010, were detected with drug-resistant TB. Of them, 14 had MDR-TB, 11 had partial XDR (apart from being MDR they were resistant to injections in second line treatment) and one was identified with XDR.

(Names of all patients have been changed)


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