Much has been said and shown about tuberculosis (TB) with several films
having shown people constantly coughing and being diagnosed with the
condition. It is preventable and treatable, yet the condition of
tuberculosis ( TB) continues to be a major health threat, because of
growing drug resistance and spiralling costs of treatment. That apart,
fears and stigmas around the condition are abound. The TB scenario has
only left doctors perplexed. "India is a heavy TB burden country. In
urban settings , the problem is more severe compared to rural settings
as the rate of transmission is higher due to overcrowded spaces.
Patients from lower socio- economic status cannot afford diagnostic
tests and anti- tubercular drugs, thus are diagnosed later and continue
to spread the disease. Also, improper medication (irregularities in
taking medicines by the patients or incorrect treatment regimen by
private medical practitioners), leads to emergence of drug- resistant TB
strains. Thus, worseningthe situation," says Dr BR Das, president, research and innovation, SRL
Diagnostics. Drug resistance: major threat Rising drug incidence happens
to be the biggest threat to TB control and cure. Drug resistant TB
happens when the bacteria develops resistance to the most commonly used
drugs in the first line of treatment regimen, leading to multidrug-
resistant TB ( MDR- TB) and in extreme cases, extensively drug resistant
TB ( XDR TB), where the bacteria fail to respond to even second line
drugs," says Dr Chandan Kedawat, internal medicine specialist, PSRI
Hospital. The other problem is that of patients not sticking to their
drug regimen. " They end up discontinuing it because they feel better
within a few weeks whereas the medicines should be taken for six
months," points out Dr Kedawat. Poor drug regulation TB control has also
become a challenge because of poor drug regulation and spiralling
treatment costs. " Poor drug regulation has fuelled drug resistant TB,
along with lack of discipline when it comes to TB regimen. There is no
accountability, when it comes to adhering to proper diagnostic and
treatment rules," says Dr Swati Sharma, New Delhi based internal
medicine specialist. According to experts, lack of drug regulation has
made even basic treatment of drug- sensitive TB difficult to monitor. "
There are so many different formulations of TB drugs sold across and
absolutely no monitoring," adds Dr Sharma.
Irrational prescription and indiscriminate use of non- WHO recommended
drug regimens has become a huge problem. " It is the patients who suffer
the consequences of poor regulation of TB drug formulations in India.
An increasing number of our patients are being diagnosed with drug
resistant TB ( DR- TB). We encounter a spectrum of resistance patterns
which range from mono- drugresistant TB all the way through to
extensively drug- resistant TB ( XDR TB)," says Dr Simon Janes, medical
coordinator, Médecins Sans Frontières ( MSF) India.
Hence other diagnostic tests need to be performed to consider
initiating antitubercular treatment. There are also other conditions,
symptoms of which are familiar to TB. " Conditions like amyloidosis and
sarcoidosis, have symptoms similar to TB too. And often it is too before
the correct diagnosis happens," says Dr Kedawat.
Say TB, and the first thing that might strike you is a cloudy chest X-
ray. But there are several other forms of TB which affect other organs
of the body like that of skin, intenstinal, lymph nodemusculoskeletal,
central nervous system, gastrointestinal, skin, pericardial, among
others.
Way forward
Apart from systemic policy changes, there is much that can be achieved
by individual efforts, which are as simple as sticking to your medicine
regimen beginning with the first line of treatment.
" It is important to follow proper guidelines, avoid using anti TB
medication for any other purpose other then TB, stick to total duration
of care as treatment being of longer duration there is the tendency to
default which leads to treatment failure and building up of resistance,"
says Dr Mansoor.
While most of us are exposed to TB during our lifetime, those with low
immunity are more likely to contract it. So one of the ways to keep it
off you and combat this condition when it strikes, is to build your
immunity; gradually and naturally.
