By Prabhat Prakash & Prarthana Sharma

New Delhi: Drug-resistant tuberculosis (TB) is a major threat to world health, especially with the rise of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). These strains resist the most potent TB drugs, complicating treatment regimens and increasing the need for novel remedies. Recognising the crucial need for effective interventions, the Indian government has launched a multifaceted plan to combat drug-resistant tuberculosis (TB).

The emergence of MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) poses a significant threat to global health. Stringent infection control measures are required to reduce the occurrence of these resistant types of tuberculosis. Key methods include ensuring that healthcare facilities offer well-ventilated and separated rooms for patients with drug-resistant tuberculosis. To minimise the danger of infection, treating physicians and healthcare workers must use personal protective equipment (PPE).

Necessary resources for comprehensive TB treatment

Patients undergoing long-term and sophisticated drug-resistant tuberculosis therapies require extensive support networks. Access to specialised healthcare personnel, like infectious disease specialists and tuberculosis nurses, is critical for tracking treatment progress and improving patient outcomes. Support groups and counselling services assist patients handle the emotional toll of long-term therapy by addressing concerns such as sadness, stress, and worry.

Interacting with ETHealthworld on the treatment regime needed, Dr Samir Garde, Director, Dept of Pulmonology and Lung Transplant, Gleneagles Hospital, Parel, emphasised, “Those undergoing long-term and sophisticated drug-resistant tuberculosis treatments should have access to the resources necessary to provide comprehensive care to TB patients. There should be available professional doctors, such as infectious disease specialists and tuberculosis nurses, who are skilled and knowledgeable enough to evaluate treatment progress and improve the patient’s quality of life. Patients should be educated as well. The Internet portals offer information, educational recommendations, and virtual consultations to those in need of TB treatment. These resources will assist patients in controlling tuberculosis.”

Novel drugs transforming treatment

Dr Harshad Limaye, Senior Consultant, Infectious Diseases & Internal Medicine, Nanavati Max Super Speciality Hospital, Mumbai, highlighted, “In India, the development of novel drugs such as Bedaquiline and Pretomanid has transformed the treatment of drug-resistant tuberculosis (TB), dramatically reducing the time required for effective therapy. These medications are highly regulated by the government to prevent misuse, but they are also available to private practitioners through collaboration with government health authorities.”

Dr Manisha Mendiratta, Associate Director & Head, Pulmonology, Sarvodaya Hospital, Faridabad, said, “The most important thing to do to reduce the occurrence of MDR and XDR is to prevent the abuse of TB medications. And, under the DOTS system, the medicines should not be added until we receive the drug sensitivity data. Given the rising prevalence of MDR TB, the government has mandated that all patients who have begun anti-TB treatment or have been diagnosed as TB positive undergo a special test known as CBNAAT to rule out multi-drug resistance from the start of treatment. The drugs are then distributed for free, with some restricted drugs available only at specified centres and not as over-the-counter drugs.”

Treatment regimens for MDR-TB and XDR-TB are much more difficult and time-consuming than those for drug-susceptible TB. These individuals frequently require treatment for several months to years, depending on their healing rate. They should also be constantly monitored for side effects, as the antibiotics used can have serious consequences.

Dr Kamlesh Pandey, Consultant Chest Physician, Wockhardt Hospitals, Mira Road, highlighted, “The treatment strategies for MDR-TB and XDR-TB differ from those for drug-susceptible TB. Patients with MDR-TB will require prolonged treatment. The medications prescribed to MDR-TB and XDR-TB patients differ from those for drug-susceptible TB. To combat XDR-TB, a complete treatment plan will be implemented, with a team of professionals, including infectious disease specialists and pulmonologists, providing the best possible care throughout the treatment process.”

Patients with drug-resistant tuberculosis have a higher chance of treatment failure and recurrence than those with drug-susceptible TB. Regular follow-ups, examinations, and screenings are critical for improving their condition. Newer drug choices, when used under the guidance of a healthcare expert, may produce superior results. A multidisciplinary strategy including competent professionals, timely medication adherence, and continual physical and psychological care is critical for the efficient management of these individuals.

Tackling medication resistance TB with newer technologies

The growing problem of medication resistance in tuberculosis needs the introduction of new technology and research findings into existing treatment strategies. Gene sequencing techniques can detect drug-resistant bacteria early, enabling personalised treatment programmes tailored to each patient’s specific needs. Artificial intelligence (AI) is an important tool for evaluating resistance trends and modifying treatment regimens for patients.

Addressing the medication resistance, Dr Krutarth Kanjiya, Fever and Critical Infection Specialist, Sterling Hospitals, Rajkot, said, “Medication resistance in tuberculosis can be tackled by incorporating new technologies and research findings into existing control strategies. Rapid molecular tests, like Xpert MTB/RIF Ultra, can detect drug resistance immediately, allowing for timely modifications to treatment programmes. Whole-genome sequencing provides precise information about resistance mutations, guiding individualised treatment strategies. Developing new medications such as Bedaquiline and Pretomanid provides more effective choices against resistant strains.”

Need for educational programmes, initiatives, public awareness drives

Sharing his views on how outbreaks can be tracked and controlled and public health activities can be influenced, Dr John Muchahary, Consultant – Interventional Pulmonology, Manipal Hospital Goa, stated, “Improving tuberculosis surveillance systems to detect and track drug-resistant patients is critical for controlling outbreaks and influencing public health initiatives. Implementing strong infection control procedures in healthcare settings, such as utilising personal protective equipment (PPE), providing enough ventilation, and separating infectious patients, can greatly minimise tuberculosis spread. Public health initiatives that educate people about tuberculosis symptoms, transmission, and the significance of finishing treatment aid in early detection and prevention of transmission.”

Educational programmes, initiatives, and public awareness drives are required to involve communities. Celebrities and public personalities can help to magnify the message and raise public awareness through these initiatives. Providing free TB drugs ensures that financial constraints do not prevent treatment adherence. Educating children and young people about tuberculosis in schools and colleges can promote early detection and prevention.

Accessibility to healthcare services at grassroots level

The efficient management and treatment of MDR-TB and XDR-TB require the reinforcement of healthcare systems. Telemedicine services can be extremely beneficial to patients, allowing for quick consultations, monitoring, and assistance, particularly in remote places. Access to healthcare services at the grassroots level can address concerns such as high travel expenses and lengthy wait times, ensuring that more patients receive timely care.

Dr Vinus Taneja, Consultant, Internal Medicine, Sir Ganga Ram Hospital, mentioned, “The national strategic plan for tuberculosis elimination 2017-2025 is based on four strategies: detect, treat, prevent, and build. Its goal is to achieve a rapid drop in the TB burden and to eliminate TB by 2025. Although we are still a long way from achieving this goal, we have made significant progress in the fight against tuberculosis. Multi-drug resistant tuberculosis or extensively drug-resistant tuberculosis.”

MDR-TB and XDR-TB demand a comprehensive and diversified approach. An effective TB control strategy must include stringent infection prevention measures, specialised patient resources, advanced treatment regimens, novel technologies, and vigorous public health initiatives. Strengthening healthcare systems, utilising new research and technology can enhance drug-resistant tuberculosis management and treatment, lowering its prevalence and impact on global health.

  • Published On Jun 10, 2024 at 03:28 PM IST

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