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Docs find medicine mix to fend off
drug-resistant TB

Six months after reports came in of 'totally drug resistant tuberculosis (TDR TB)' from Mumbai, a "salvage regimen" for the disease has found positive response among several victims.

The news of the drug-resistant TB had alarmed experts, including the World Health Organisation (WHO), and this new treatment could demolish apprehensions about return of the "white plague" — a reference to the times when TB was incurable.

Dr Zarir F Udwadia, consultant chest physician at Mumbai's Hinduja Hospital, said that six of the 15 patients whom he and his team had termed TDR in a paper in the journal, Clinical Infectious Diseases, last December had shown improvement. The cultures of five of them had changed from positive to negative and three had shown changes in X-rays.

In the paper, Dr Udwadia had defined TDR TB as a bacterial strain that did not respond to all first-line (isoniazide, rifampicin, ethambutol, pyrazinamide and streptomycin) and second-line (ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, paraaminosalicylic acid and ethionamide) drugs.The "salvage regimen" comprises all other medicines/surgical options left open. Among these are double dose isoniazid, linezolid, meropenem, clofazamine, etc. Some of these drugs are toxic tertiary antibiotics and others are usually used for diseases other than TB, but in a five-six drug combination, these were found to be helpful in taming the extra drug-resistant variety of the disease.

"Salvage regimen is patient specific. There are some very positive outcomes we have found in the 15 TDR TB patients we reported. This includes one patient who is HIV-positive. Different regimens have worked for different patients and at the moment it is difficult to put a timeline to it. All of them will likely have to continue the drugs for three years at least," said Dr Udwadia, speaking to The Indian Express from Mumbai.

The doctor added that many of the patients have now gone back to DOTS. "These drugs are very expensive, so if they get three-four drugs from the government for free (under DOTS) it helps. The rest they buy from the market, making it a unique example of public private partnership. The NGO Medicins Sans Frontiers has adopted the HIV-positive patient," Dr Udwadia said.

The TDR TB nomenclature had been a controversial one, with the Union Health Ministry accepting the findings of Hinduja Hospital but refusing to identify it as a separate bacteria strain on the ground that there was no definition or lab findings to support such a classification.

In March, a high-level meeting of WHO health experts in Geneva had ruled that there was currently insufficient evidence to adopt new case definitions for drug-resistant TB.

"Drug susceptibility testing, which is key to defining new levels of drug resistance, lacks accuracy for several of the drugs that are used to treat multi-drug-resistant and extensively-drug-resistant TB... New drugs are currently undergoing clinical trials and could prove effective against drug-resistant strains," the WHO held.

Salvage regimen

It comprises double dose isoniazid, linezolid, meropenem, clofazamine, etc Some of these drugs are toxic tertiary antibiotics and others are usually used for diseases other than TB, but in a five-six drug combination, these were found to be helpful in taming the extra drug-resistant variety of the disease Doctors claim salvage regimen is patient-specific.

Courtesy: The Indian Express, July 2012

 
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