India: Govt to roll out daily drug treatment for TB

The move follows findings by experts which revealed that the old regimen led to increasing instances of drug resistance and relapse. Relapse occurs when a patient is declared 'cured' by a doctor tests positive for tuberculosis again.

"The Union ministry of health and family welfare has decided to start daily drug therapy for TB patients. Initially, the new treatment protocol will be implemented in five states during January-February 2016. It will be rolled out across the country in a phased manner thereafter," Sunil Khaparde, deputy director general (TB control), Union health ministry told TOI on Wednesday (September 16).

State tuberculosis officer Sanjeev Kamble said the new regimen will benefit over 1.25 lakh TB patients in Maharashtra. "The new treatment protocol focuses on daily treatment regimen as against intermittent drug therapy. It will drastically raise the need of TB drugs which will be provided free to all patients in Maharashtra," Kamble said.

"There are many patients under private care who are not regular in their treatment. Skipping drugs or leaving the treatment midway can lead to multi-drug resistant TB (MDR-TB) or in the worst case, even death," he added.

Yogesh Jain, public health physician and paediatrician at Jan Swasthya Sahyog, said: "We can make many changes to improve the outcomes of TB patients in India by offering drug-sensitivity testing, supplementary food while preventing childhood disease through contact screening. However, the most urgently needed change is introducing daily drug regimens for all tuberculosis patients."

Jain, who has published research papers highlighting the importance of initiating daily drug treatment in tuberculosis, said, "Data shows that resistance to a single first line drug (isoniazid, ethambutol, or streptomycin) drives the development of MDR disease. National data on drug resistance have shown consistently high resistance to isoniazid, with rates of up to 40% in new patients. Therefore, intermittent therapy can no longer be considered an effective empirical regime."

Barring India, 127 of 132 countries that started with intermittent treatment regimen have already switched to daily treatment.

KEY FACTS

The revised national tuberculosis control programme was launched in India in 1997 which was based on WHO-advised directly observed treatment strategy (DOTS), where treatment was given three times a week

The lower cost of drugs and feasibility of supervised dosing were factors thought to favour the intermittent treatment

However, the programme did not collect data about relapses and the emergence of drug resistance

Studies done in several parts of the country show that relapses are closer to 10% or more in patients who received intermittent treatment compared with 5% among patients who received drugs daily

Relapses, when disease recurs after successful treatment, contributed to more patients with multi-drug resistance (MDR) disease than treatment failure

TREATMENT IN OTHER COUNTRIES

Except India and one province of China, no other country in the world uses the intermittent regimen in the intensive phase

Among the remaining 130 countries, Peru, Columbia, Cuba, and Uruguay use intermittent therapy only in the continuation phase after daily treatment in the intensive phase

WHY THE DELAY IN ADOPTING NEW DRUG REGIMEN

The cost, although no cost effectiveness study accounts for the cost of relapses and drug resistance

Supervised treatment seven days a week presents a logistical challenge, when the programme is unable to effectively supervise thrice weekly regimens

BENEFITS OF DAILY TREATMENT

Daily treatment can have equally high compliance rates with the added benefit of less harm that may accrue out of a single missed dose compared with the thrice weekly regimen

The increasing numbers of patients with MDR disease in India and lessons learnt from the rest of the world suggest that it is high time India opts for daily drug regimen.

Source: The Times of India