Sewri TB hospital starts giving bedaquiline to outpatients

In an attempt to prioritise the comfort of patients suffering from tuberculosis, the civic-run TB hospital in Sewri has started giving bedaquiline in the outpatient department (OPD).

Patients on this drug are commonly hospitalised for the first few weeks of the six-month course to monitor them for adverse effects. But doctors at the TB hospital are now ensuring that the patients are monitored but not admitted.

So far this year, 25 drug-resistant TB patients have got bedaquiline in the OPD and eight more will get soon. “There is an obvious reluctance among patients to get hospitalised. Attendants too have to compromise on their work schedule and other daily chores. Therefore, we thought of giving drug in the OPD as a pilot project,” hospital dean Dr. Lalitkumar Anande said. He said the outpatients have been carefully chosen.

Bedaquiline is one of the two newest anti-TB drugs in 50 years, the other one being delamanid. The government has a restrictive policy of giving bedaquiline under the Revised National Tuberculosis Control Programme (RNTCP).

“One of the most feared side effects of this drug is the cardiac toxicity. The first 15-21 days are thus considered as the intensive phase where the side effects may flare up. So far, none of the OPD patients have developed any side effects which required hospitalisation,” Dr. Anande said.

The patients have the drug in presence of a doctor and their electrocardiography is carried out twice during the day. During the six-month course, patients take 400 mg of bedaquiline every day for the first two weeks and then 200 mg on alternate days. “Post the intensive phase, the patients get the drug through an RNTCP health worker and they have it in his or her presence,” Dr. Anande said.

Bedaquiline in the OPD was first given to at Shatabdi Hospital in Govandi. “We started in September last year and enrolled 100 patients and the treatment went well. The key was good coordination between the staff and the patients, and regular follow-up,” Dr. Vikas Oswal, who is at the helm of the MDR TB DOTS PLUS site at the hospital, said.

“In the cohort of 100 patients, only three required hospitalisation due to problems like electrolyte imbalance, low hemoglobin, and one death was reported as the patient defaulted on alcohol addiction,” Dr. Oswal said.