The rumbles of the nation-wide shortage of anti-tuberculosis drugs, especially the paediatric dosage combinations, are beginning to be felt in Kerala also.
A disruption in the TB drug regimen, especially in the initial months of the treatment (intensive phase), could have catastrophic effects and result in developing drug resistance.
Considering the seriousness of the situation, the Union Health Ministry has been pooling un-utilised stock of paediatric TB drug combinations and sending it to States to tide over the immediate shortage, till fresh stocks are procured.
“We have now received a share of these pooled paediatric TB drugs, which will last us for two months. It is highly unlikely that the logistics issues in procurement by the Centre will be sorted out during this time. In such an eventuality, the State could either opt for local purchase of the drugs or we may have to tailor specific paediatric dosages for various weight bands from the stock of adult drugs,” a senior Health official said.
For managing paediatric TB, fixed drug dosages are used for various weight bands and for each weight band, a specific drug box is issued.
After the WHO came out with the new and revised guidelines for paediatric TB management in 2010 November, the weight bands were further narrowed and the drug dosages were doubled. Logistics issues at the national level have now resulted in the acute shortage of new paediatric drug boxes.
As of now, Kerala has adequate drug stocks for the basic Revised National TB Control Programme (RNTCP) adult drug regimen for the next six months or more and there is no shortage of drugs for multi-drug-resistant (MDR) TB as there are adequate stocks to last a year.
Generally, 10 per cent of the total TB cases in the State is estimated to be paediatric cases but in districts such as Wayanad, this could be as high as 14 to 16 per cent. According to the data provided by the State TB Cell, the State treats about 350 new paediatric cases of TB every quarter — putting the cost of treatment for paediatric TB cases at Rs.6 to Rs.7 lakh per quarter.
The drug logistics of TB under the RNTCP for all States is managed entirely by the Union Health Ministry. Hence, the State has not set aside funds for purchasing TB drugs. However, considering the seriousness of the situation, the State has been pondering a decision to go in for local purchase, utilising funds from the National Rural Health Mission for the time being, which could later be reimbursed from the RNTCP funds. But this is not easy because there is shortage of TB drugs in the open market also.
The national TB control programme has been successful, with only a certain section of patients (estimated at about 35 per cent) seeking treatment with private-sector doctors, outside RNTCP. Hence, very few pharma shops stock TB drugs and the government may not find local procurement easy, says R.V. Ashokan, Project Coordinator of RNTCP for the Indian Medical Association.
