An alarming number of multi-drug-resistant TB (MDR TB) cases have been diagnosed in Kerala, just one year and two months after the DOTS Plus regimen for the treatment of drug-resistant tuberculosis was introduced across the State.
When the DOTS Plus regimen was launched in January last, the State expected to treat about 50 to 100 cases of MDR TB every year. This was according to the general estimate that about three per cent of the fresh cases of TB in the community and about 16 to 18 per cent of re-treatment cases (patients who were not cured after a course of first-line TB drugs) would be MDR TB.
However, in the past one year, 200 confirmed cases of MDR TB have been detected in the State. As many as 152 of these patients have been put on the DOTS Plus regimen, while the others are waiting to be inducted into the programme. The high number of cases has thrown up another problem: shortage of second-line drugs, supplied to the Health Department by the Central TB Division.
With more cases surfacing, there has been a shortage of one of the daily injectible drugs for MDR TB, Kanamycin. The Health Department has been managing it through local supplies, but if the supply of drugs from the Centre does not regularise, it could affect the DOTS Plus programme in the State.
“Not much of the second-line TB drugs are manufactured in India and there is bound to be a shortage. The high number of MDR cases is not exactly a surprise because till now, we have not had any diagnostic facility to detect drug-resistant TB,” said R.V. Asokan, IMA's national coordinator for TB control.