In seven out of every ten patients detected with drug –resistant Tuberculosis (TB) in Mumbai, four drugs out of the six-drug cocktail are ineffective, according to a study by doctors at PD Hinduja Hospital in Mahim which said that a new drug regime that looked at a patient’s unique requirements instead of a standard prescription for everyone, was needed to control the disease.
The drugs are given as a part of the government’s TB control program and the hospital’s study indicates that the drug combination worked in just over a third of the patients. The rest, researchers said, were consuming pills that the TB bacteria in their body were resistant to. The findings of the study will be published in the Lung India, a scientific journal.
“Ideally what we need is a new regimen of drugs,” said Dr Zarir Udwadia, chest physician at the hospital who has conducted the study along with his colleagues. “Adding a new drug to the existing regimen is a domed (approach).On its own, a new drug is worthless.”
The study tried to find out whether the current blanket anti-TB program running in India is working. At present, a multidrug-resistant TB patient registered under the government’s Revised National TB Control Program (RNTCP) will receive a cocktail of six drugs. The patient will be put on the drugs without conducting a drug susceptibility test (DST) to know which drugs will be effective in killing the TB bacteria they are infected with. “The susceptibility test should be made available to all patients. We have to individualise treatment with the help of DST” said Dr Camilla Rodrigues, consultant microbiologist at the hospital.
In the study, the doctors tested sputum samples of 1,539 patients, of which, 464 had drug-resistant bacteria. In 30% of these patients, only three of six drugs were effective whereas in 9% of them only one of the six known anti-TB drug was effective. “TB is in everybody’s backyard,” said Dr Rodrigues who was consulted recently by a pilot diagnosed of multi-drug resistant TB. “If you don’t get effective treatment, it continues to spread.” The larger problem is not just that the patients are getting ineffective treatment but also they continue to spread the bacteria in the community where they live. It is only when a patient’s sputum is negative for the bacteria, the person stops spreading the bacteria to others.
PD Hinduja Hospital was the first in the country to record the presence of totally drug-resistant tuberculosis, a classification World Health Organisation is still to accept. International health agencies said that the most resistant form of TB is classified as extensively drug resistant (XDR) TB as there are salvage drugs available to treat.
Though the government is increasing the availability of diagnostic facilities to detect patients with resistant TB, it has little to improve the accessibility to drug susceptibility tests. “Providing the GeneXpert (diagnostic test for detecting drug-resistant cases) to just 15% of the suspected TB patients would consume the entire annual TB budget,” said Udwadia.
Government medical officers said that it is difficult to start DST facilities at their hospital. Dr Sunil D Khaparde, deputy director general, (TB), said, “I have not seen the study so it is difficult for me to comment on the findings. There is no doubt that performing a DST is the best way to treat patients but for a public health programme, it is challenging. Till we don’t make DST available at all hospitals, individualised treatments will take time.”