First govt-funded bedaquiline treatment for TB initiated in Mumbai

August 11, 2016 - Months after the announcement of bedaquiline drug initiation to treat extremely drug-resistant tuberculosis (XDR-TB) cases, the Revised National Tuberculosis Control Program (RNTCP) finally kickstarted with its first patient in Mumbai, a Dharavi resident. This patient is the first of 100 patients expected to undergo the medication.

Until now, only Chennai and Guwahati have put patients on the bedaquiline regime — considered a ‘miracle drug’ in fighting TB. Bedaquiline was introduced in response to the World Health Organization’s call in 2012 to work on anti-TB medication at a time when the bacteria was increasingly becoming resistant to drugs.

The XDR patient, 20-year-old Mohammad Ehasan, is currently admitted at Sewri TB Hospital and has been put on advanced category five treatment. Apart from showing resistance to all first and second-line drugs, he is also resistant to isoniazid, which is used to treat extremely drug-resistant cases.

The beginning of bedaquiline medication will be a boost in the fight against the bacterial infection which has caused a rising incidence of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-)TB cases in Mumbai. According to health experts, thousands are in need of this drug although it is being rolled out selectively for extreme cases of TB.

Ehasan first showed signs of the infection in May this year and quickly developed resistance to all the drugs in three months. He first went to a private physician in Dharavi. When his coughing and vomiting fit did not end, he visited Sion Hospital and initiated treatment for normal TB infection on June 21. A culture test later showed he was resistant to almost all drugs. On July 26, he was admitted at Sewri TB hospital.

In the first week of August, the Drug Resistance TB Committee chose him as the first bedaquiline candidate after carefully testing him for any heart or diabetic problems.

The frail man, with a mask on his face at all times, does not understand the disease he is battling, nor does his family. Ehasan has three younger brothers, one sister and parents to take care of in Muzaffarpur, Bihar. He lived in a small godown in Dharavi and as a tailor made Rs 300 per day before he fell ill.

“He is the only earning member. With him ill, his old father is going to farms to earn for the family,” said his uncle Sameer ur Rehman. According to him, no one in the family has suffered from TB or knows about the disease.

While bedaquiline counselling is necessary to each patient undergoing the six-month regime, Ehasan claims he was only told that a new drug will be added to his medicines. “I do not know much about what pills I have to take,” he said. His diet comprises banana, milk, rice and daal in the hospital. To help strengthen immunity, he is given food every few hours.

The hospital and Drug Resistant TB committee will monitor his health for two weeks to see how he responds to bedaquiline, of which a small dose is administered to him daily at 1 pm.

Following that, he will be discharged and asked to visit a DOT center in Dharavi for his daily dose. Daksha Shah said the process of selecting appropriate patients for bedaquiline will require several checks which is why a delay has been observed. On August 8, The Indian Express had reported how bedaquiline delay was forcing an extremely drug-resistant patient to look for other options.

Source: The Indian Express