The girl from Govandi is resistant to 12 of the 13 anti-TB drugs that are available, which according to doctors, makes her a public hazard.
Despite contracting TB, she lives at home and frequently uses public transport.
“She travels in buses and local trains, just like most of us. Knowing that she possibly harbours a bacterial strain that is resistant to all other drugs, including Bedaquiline, she could be spreading the infection,” said Dr Oswal who is of the opinion that she could be placed in quarantine so that chances of her spreading the infection is diminished.
However, nowhere in the national TB policy is it stated that severe drug-resistant patients need to be isolated. “Doctors have to be cautious and make patients aware about spreading the infection in the community. We can’t stop patients from travelling,” said Dr Sunil Khaparde, deputy director general of the TB control programme
Delamanid, the drug that works in the girl’s case, may not help.“Delamanid is a highly advanced anti-TB drug, but its efficiency is questionable in her case as it has to be given in combination with other drugs, which she has already developed a resistance to,” said Dr Oswal.
He added, “If she doesn’t respond to it, there is nothing else that we can try.”
Her case, according to doctors, is a big public health concern as she could be spreading the infection to other people.
Her aunt, who takes care of her, has never been screened for the infection.
The aunt works as a helper in a local school that requires her to take care of children as young as four years old. “Doctors have asked me to get tested but I never seem to find the time,” she said, adding that her parents had contracted TB and succumbed to it.
She lost her mother to TB when she was nine and her father eight years later.
Her case comes in the backdrop of the recent case of an 18-year old from Patna, who was refused Bedaquline at Lala Ram Sarup TB Hospital in Delhi, on the grounds that she was not a resident of Delhi.
While hearing her case, the Delhi high court court stated that the ‘domicile’ of the patient is not a criterion for eligibility to Bedaquiline.
While this decision could mean that more TB patients could take Bedaquiline, the screening of these patients will have to be done very carefully, doctors said.
Doctors have also expressed concerns about calling Bedaquiline a ‘miracle drug’.
“When treating TB, there cannot be a single ‘miracle drug’. Any drug has to be given in combination with other drugs that are known to work,” said Dr Yatin Dholakia, technical advisor to Maharashtra State Anti-TB Association.
What is Bedaquiline?
Bedaquiline is an anti-TB drug used specifically to treat TB patients who are resistant to most powerful anti-TB drugs- rifampicin, isoniazid, any other core anti-TB drug and have developed multidrug-resistant tuberculosis
-It was the first anti-TB drug to be rolled out in the last 40 years
-It is an expensive anti-TB drug, manufactured by the Belgian company Janssen.
- While private doctors in India used it for patients on ‘compassionate-use-basis’, its access is now restricted.
Bedaquiline in Mumbai
- 56 patients in Mumbai are on the on-going Bedaquiline clinical trial, out of which, two patients had to be put off the treatment as they have developed side effects.
“At our centre, the patients who are on Bedaquiline are tolerating the drug very well,” said a senior doctor from the Group Of T B Hospital, Sewri, Mumbai, one of the six government run centres in India to provide the drug.
According to the World Health Organisation,
What is Multi Drug Resistance?
TB cases in which bacteria that cause tuberculosis develop resistance to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
Why does drug resistance emerge?
- Incomplete treatment
- Incorrect doses of the medicines
- Getting infected by a bacterial strain which is already resistant many drugs
Drug resistant TB cases are difficult to treat as medicines to treat them are limited. Severe forms of drug resistance result in increased mortalities.