India: A daily dose to fight tuberculosis more effectively

Nov 17, 2015 - The battle against tuberculosis (TB) will get a massive boost, with Maharashtra and four other states set to roll out the daily drug regimen for patients starting next year. Most countries have already adopted the daily drug regimen, but India still continues with the intermittent regimen that involves giving medicines thrice a week under the Directly Observed Treatment Strategy (DOTS).

Now, the daily drug regimen will be introduced in Maharashtra, Kerala, Himachal Pradesh, Bihar and Sikkim. "We have decided to introduce the daily drug regimen in 104 districts across five states," said Dr Sunil Khaparde, deputy director general (TB), Directorate General of Health Services. He said that the training of health workers and procurement of the drugs have already begun.

Doctors and TB experts have for long blamed the intermittent regimen for increasing the burden of drug-resistant TB. The move to introduce the daily drug regimen has been called a "game-changer" by the doctors, who feel that the burden of drug resistant TB will reduce drastically.

"Though no study shows that daily treatment is better than intermittent, many physicians feel that this is a more effective way and that the chance of relapse is less likely," said the Hinduja Hospital's chest physician, Dr Zarir Udwadia. "It's a step in the right direction. Daily treatment is especially useful to those suffering from extensive TB, diabetics and those with HIV. Besides, it is a norm worldwide," he said.

The intermittent regimen involves giving medicines to patients on Monday, Wednesday and Friday under the supervision of a healthcare worker. This regimen consisting of a combination four drugs and one injection is applicable to the first-level TB patients registered under the Revised National Tuberculosis Control Programme (RNTCP), who have not developed resistance to medicines.

"The gap in between the treatment actually leads to resistance and patients suffer from multi-drug resistance (MDR) TB," chief medical officer of Sewri TB Hospital, Dr Lalitkumar Anande, said. "It is the basic of pharmacology. When the drug is constantly present in the body, a plateau is formed, and the drug always remains above the therapeutic level fighting the bacteria constantly. When there is a gap in between, this plateau is never formed," Anande said.

The World Health Organisation has said that India has over 28 lakh TB patients, with over 64,000 suspected to be multidrug-resistant (MDR) cases. Of these, a merely 30% are said to be registered under the RNTCP for free treatment.

Dr Yatin Dholakia, secretary of the Maharashtra State Anti-TB Association, said that the daily drug regimen has been long awaited. "We have fought with the government for over a decade to implement this system as we believe it will change the TB scenario to a vast extent," Dholakia said. The battle against TB is not easy as it took ten years for the government to roll out the intermittent regimen under DOTS for entire country, he said. "Now that they are starting with five states, covering the entire country looks at least five to seven years away," he said.

The British Medical Journal (BMJ), in 2013, had said that except India and one province in China, no other country uses an intermittent regimen in the intensive phase.

Source: Mumbai Mirror