After the delay of nearly a year, the State is rolling out the daily drug regimen for the treatment of tuberculosis under the Revised National Tuberculosis Control Programme (RNTCP).
Health Minister K.K. Shylaja will formally announce the launch here on Tuesday. This is a major shift in the TB treatment policy that has been followed by the Central TB Division since 1997.
Among five States
Kerala is one of the five States where the new regimen is piloted.
Since 1997, patients under RNTCP were being administered drugs thrice a week. However, the private-sector physicians preferred to put their patients on a daily regimen of tailor-made drug combinations and dosages.
Amidst arguments at various levels that this total variance in treatment practices and the innumerable drug combinations were encouraging drug resistance, the WHO revised its TB management guidelines in 2010, recommending that the daily drug regimen be adopted under RNTCP.
“Under the new daily drug regimen, TB patients will be given fixed drug combinations (FDCs) — three or four drugs in specific dosages in a single pill — on a daily basis. The drugs will be administered according to the weight of the patient.
The advantage for the patient will be the reduced pill burden, as instead of seven tablets, patients need to consume only 2 or 3 tablets. FDCs are also expected to improve treatment adherence and acceptability and in general, simplify the treatment for the patient,” senior RNTCP officials said.
However, increased pharmacovigilance might be in order as TB drugs are highly toxic.
Child patients
For child patients, new flavoured, dispersible tablets are being introduced. Kerala, incidentally, has the lowest TB-affected child population at 6% (2015).
The move to the daily drug regimen is expected to bring in an increased enrolment of patients in RNTCP in the State, by at least 20%.
However, the key guiding principle of RNTCP — Directly Observed Treatment (DOT) or directly supervised treatment of each TB patient with the help of community volunteers — will not be compromised.
Supervised treatment
Supervised treatment is important as TB drugs have considerable side effects. Many patients interrupt treatment because of aversion to these drugs, which affects the cure and leads to the development of drug resistance.
“We will follow DOT, even under daily drug therapy, but the process is being made very flexible. The supervision could be daily or made weekly. The supervisor can even be a family member. We are also exploring if ICT-supported programmes, like an SMS alert or a pre-programmed phone call can be used to ensure treatment adherence,” officials said.
