C. Maya

Ensuring standard diagnosis and treatment protocols necessary

Thiruvananthapuram: The low acceptance of the Revised National Tuberculosis Control Programme (RNTCP), with its DOTS strategy (Directly Observed Treatment, Short course), among a large section of private medical practitioners in the State has emerged as a major concern for health managers, who point out that a substantial number of TB cases are treated in the private health sector and go without being notified.

While the advocates of the national programme claim that a uniform strategy, ensuring standard diagnosis and treatment protocols, is absolutely essential for controlling TB in the community, the private medical practitioners aver that a standardised treatment approach cannot work for all TB patients.

Under the RNTCP-DOTS strategy, fixed drugs are given in specific combinations once a week to patients by a DOTS provider and each dose administered to the patient is supervised to ensure treatment compliance. This concept of intermittent chemotherapy has been unacceptable to most private medical practitioners, who still insist on a daily drug regimen.

RNTCP officials claim that strictly supervised intermittent therapy is superior to unsupervised daily administration of drugs. Drug toxicity and side effect is only about 6 to 7 per cent when drugs are administered weekly, as against 40 per cent in the case of daily regimen.

Adherence to treatment is a critical factor in determining treatment success in tuberculosis. This is not easy because of the long duration of the treatment and the side effects of the drugs. The general trend has been that even when the treatment is directly supervised, most patients default after the second month of treatment, when their symptoms disappear.

"The spirit of RNTCP is that the system takes the responsibility of curing the patient by ensuring treatment adherence. DOTS strategy has achieved a cure rate of over 85 per cent in the State," points out a senior Health Department official.

Physicians in the private health care sector often deviate from standard, internationally recommended tuberculosis management practices and use non-recommended drug regimens, with incorrect combinations of drugs, incorrect dosage and duration of treatment and fail to assure adherence to treatment, it is alleged

"Most private practitioners seem to be prescribing five first-line TB drugs in combination with a second-line drug. This irrational prescription of second line drugs will give rise to more drug-resistant strains of the bacteria," says an RNTCP official. However, there are many chest physicians who feel that the RNTCP-DOTS strategy is just another half-hearted public health initiative, the success and the efficacy of which is very much suspect"Standardised treatment will leave many half-treated, who will continue to spread the disease," says P. Ravindran, former Professor of Respiratory Medicine, Medical College.