With rising cases of pre-extremely drug resistant TB (XDR-TB) in children and unavailability of drugs to tackle them, doctors in the city are worried.
Dr Ira Shah, who runs a TB clinic at Bai Jerbai Wadia Hospital for Children at Parel, has got 250 cases of drug-resistant TB in children. “Most of them have pre-XDR TB. This is the first time they have contracted TB, which means they are being infected with the resistant strain of the bacteria,” said Dr Shah, paediatric infectious diseases expert.
Another challenge is the unavailability of drugs meant for children. There are specific dosages that a child suffering from TB needs, depending on his weight. “We require advanced drugs in formulations meant for children. Right now, we give them the capsules meant for adult patients, which they have to break into smaller parts. This affects the overall outcome of the treatment,” said Dr Shah.
Earlier, doctors had said patients who drop out of anti-TB treatment develop resistance to the first line of drugs and develop multi-drug resistant TB. However, in several recent cases, children are showing resistance to both first and second line of drugs during the initial test. “We have to give them drugs that are not routinely given for TB in the government programme,” said Dr Shah, who has prescribed drugs used to treat leprosy for children infected with resistant bacteria as a last resort. “I just examined an eight-year-old boy who has TB of the brain and is resistant to most of the drugs.”
India has recorded a 13% rise in TB cases among children between 2013 and 2014, according to a paper published in the International Journal of Tuberculosis and Lung Diseases. “The data clearly shows drug-resistant TB is common in children, especially in Mumbai,” said Dr Soumya Swaminathan, chief of Indian Council of Medical Research.
Dr Swaminathan said the unavailability of paediatric formulation for TB is a global problem. “It is an issue, but we have seen that if the case is detected early and children are put on medicines in time they respond well,” she said.
Dr Nerges Mistry from Foundation for Medical Research that has conducted research on tuberculosis said issues pertaining to sanitation, housing and nutrition also need to be addressed in the battle against TB.