India: WHO's shorter treatment for multidrug-resistant TB, city may not gain

But many Indian patients, especially those in Mumbai, may not benefit from this shortened regimen. They will, unfortunately , have to continue with the conventional regimen comprising 14,600 tablets and 240 injections that cost over Rs 2 lakh in the private sector. The reason, according to experts, is the widespread antibiotic resistance that has rendered most drugs ineffective. Drug resistance occurs when people have used them often and not always for the right reason and dosage; the microbes develop resistance against these drugs.

The shortened drug regimen may not work for most patients in Mumbai, which is called the TB capital of India after the emergence of totally drug-resistant TB in 2011; doctors at Hinduja Hospital, Mahim, identified patients in whom most drugs known to treat TB were ineffective.

Across the world, especially in neighbouring Bangladesh, the WHO announcement was met with enthusiasm. Bangladesh was among the 13 countries where the nine-month regimen was tested in the last couple of years.

Indian Council for Medical Research director-general Dr Soumya Swaminathan said, "The WHO nod essentially means doctors can use this ninemonth regimen that is easier on patients. However, there are many `ifs' and `buts' attached to this regimen as it may work only in certain situations."

Dr Zarir Udwadia, chest consultant, Hinduja, who identified and reported about the totally drug resistant patients in Mumbai, said, "This has as much chance of working successfully in India as the proverbial snowflake in hell." He said most patients in Mumbai are already resistant to three to four components of that "one size fit all" regimen given to all MDR-TB patients by the government-run Revised National Tuberculosis Control Programme.

The shorter regimen includes wellknown TB drugs such as ethambutol, pyrazinamide and moxifloxacin. "But we have done studies to show many of our patients are already resistant to these three drugs," said Dr Udwadia.

"The WHO announcement for shorter drug regimen and novel diagnostic testing for second-line resistance will be useful for patients across the world," said Medicins Sans Frontieres (MSF) Shailly Gupta. She added in India it would underline the need for second-line resistance testing right at the beginning (as soon as a patient is diagnosed with TB). MSF has for long been campaigning for a shorter MDR TB treatment. Meanwhile, WHO also gave an app roval to a `novel diagnostic test'. Called MTBDRsl, it is a DNA-based test that identifies genetic mutations in MDRTB strains within 24-48 hours, down from the three months or longer currently required. A press release of the WHO on Thursday said, "The much faster turnaround time means MDRTB patients with additional resistance are not only diagnosed more quickly , but can quickly be placed on appropriate second-line regimens.''

Source: The Times of India