Doctors at the PD Hinduja Hospital have found that 70 per cent of the MDR-TB patients they tested as part of a study were resistant to four of the six drugs given as standardised Category IV treatment. Experts at the hospital said the standardised treatment course of multi-drug resistant (MDR) tuberculosis patients could be driving them to extremely drug resistant (XDR-TB) category.
The study, scheduled to be published soon in Lung India journal, was conducted by doctors at the PD Hinduja Hospital in 2012, during which samples of 1,529 tuberculosis patients were analysed. Of these, just about 33 per cent responded to the drugs given under the treatment regimen.
“Category IV treatment may work in remote places where patients have not been exposed to second-line drugs, but our patients (in Mumbai) have been exposed to drugs. Individualised treatment is the solution, but here you are giving drugs to patients who are resistant,” said Dr Zarir F Udwadia, consultant chest physician with Hinduja Hospital.
The revised National Tuberculosis Control Programme Category IV treatment is a 24-month standardised second-line regimen, which includes giving MDR patients a combination of four drugs – Kanamyxcin, Moxifloxacin, Ethionamide, and Cycloserine – the second line of drugs used for patients who, by virtue of their drug resistance, have moved from Category I, which is for drug-susceptible cases to category IV. Category IV is for patients requiring treatment for MDR-TB, and Category V for patients requiring treatment for XDR-TB.
Speaking to mediapersons on Tuesday on myths about tuberculosis ahead of World Tuberculosis Day on March 24, Dr Udwadia said DOTS (Directly Observed Treatment Short course) may not be as successful as it is made out to be.
“DOTS, in some ways, could be contributing to MDR TB,” he said, pointing out that Category I standard treatment may contribute to MDR as it over relies on sputum positive cultures. So in the case of a negative result, is started on DOTS treatment late. “This duration of six months is too short for some of our patients undergoing TB treatment, and here it stops at six months,” he said.
And then, there are only two weight bands that decide dosage. “So if you fall at either extreme or in between, you could under-dosed or over-dosed.” He added that though supervision of accurate drug intake is important, but cannot be the sole focus of DOTS.
Besides, he pointed out, “Close to 100 per cent of the country is covered by DOTS, but it has not made a difference in the bottomline. Death rates from TB have risen over the years, indicating something is going wrong,” he said. He further noted that DOTS had achieved its basic role of looking after sensitive TB patients, “but something is wrong if cases are going up and not down,” he said.
These are critical concerns, as unlike earlier, when MDR was seen in cases after years of bad TB treatment, MDR is now being seen from a sputum sample collected from a suspected patient, usually contracted by a family member. “MDR is as infectious as any other form of the disease,” he said.
Dr Camila Rodrigues, consultant microbiologist and chairperson of the Infection Control Committee at Hinduja Hospital, who was also part of the study, said drugs that were once effective have lost their efficacy because of their rampant use for much smaller conditions. However, she pointed out, Mumbai was a rarity for accepting the problem.
