Multidrug-resistant tuberculosis (MDR-TB) poses a significant challenge to global public health, particularly in cases where the lungs are affected. In comparison to TB affecting other organs, MDR-TB is more prevalent when the lungs are involved. This phenomenon can be attributed to several factors.
The lungs serve as the primary site of infection for tuberculosis, making them more susceptible to acquiring the disease from another MDR TB patient.
TB bacteria proliferate in large numbers within the lungs (unlike TB in other organs), making it more likely for spontaneous mutations to occur and drug resistance to emerge.
Standard treatment for TB involves a combination of antibiotics over an extended period, typically six to nine months.
However, non-adherence to treatment regimens, missing some drugs or under-dosing or not completing the prescribed duration of treatment leads to the emergence of drug resistance TB. Various socioeconomic factors, stigma, and lack of access to healthcare services also contribute significantly.
What is multidrug-resistant tuberculosis?
A TB patient whose TB bacteria are resistant to both Isoniazid and Rifampicin (the most powerful anti-tubercular drugs) with or without resistance to other (first-line) drugs is said to have multi-drug resistant TB (MDR-TB).
MDR-TB patients may have additional resistance to any/all Fluoroquinolones or any/all second-line injectable anti-TB drug.
Burden of Multidrug-resistant tuberculosis in India
As of March 2021, an estimated 1,24,000 (9.1/lakh population) MDR/Rifampicin Resistant – TB cases are there in India. Death rates for MDR-TB are around 20%.
National game plan for TB
The National Strategic Plan (NSP) 2017–25 for ending TB by 2025 has been launched. It has four strategic pillars, “Detect-Treat-Prevent-Build” (DTPB) to achieve TB-free India as envisaged in the National Tuberculosis Elimination Programme (2020).
Details are as follows:
Prevent:
- Airborne infection control measures at the facility, household, and community level.
- By providing effective TB preventive treatment (TPT) to all household contacts of MDR/RR-TB cases.
- Transmission can be reduced by addressing the non-specific determinants like access to care, comorbidities, and public awareness about morbidity and mortality associated with MDR-TB.
Detect: Early, accurate, and affordable diagnosis of MDR-TB is being done by upfront Nucleic Acid Amplification test (NAAT) testing for all presumptive TB cases, especially in high-risk populations such as those household contacts of MDR cases, previously treated TB cases, people living with HIV and coming from areas of high local prevalence of MDR-TB.
Every case of TB should undergo drug susceptibility testing to maximise the results.
Treatment: Every case of MDR/RR-TB should receive treatment and management of DR-TB in line with guidelines of a shorter oral Bedaquiline-containing MDR/RR-TB regimen at the earliest from a designated DDR-TB centre of the government or authorised DR-TBC in a private setup.
The success rate of a shorter oral Bedaquiline-containing regimen is around 71%, which is superior to a previously administered injectable DR TB regimen(60%) that was prolonged and had lots of side effects.
Build: Capacity building by mandatory national level training of all involved officers from the national level to nodal and district level officers and by engaging the private health service delivery sector for MDR TB care.
To summarise, early diagnosis of TB and mandatory rapid drug sensitivity testing and adequate standardised treatment can not only decrease TB cases in the population but also tackle the MDR TB menace effectively.
All government and private sector doctors need to be involved in this national mission.
Comprehensive strategies focusing on improving treatment adherence, enhancing healthcare access, and implementing effective infection control measures are needed to tackle the MDR TB challenge facing India.
Disclaimer: This is an authored article. The views and opinions expressed by the doctors are their independent professional judgement, and we do not take any responsibility for the accuracy of their views. This should not be considered as a substitute for physician’s advice. Please consult your treating physician for more details.
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