While the World Health Organization (WHO) has made important changes to the treatment guidelines for multidrug-resistant tuberculosis (MDR-TB) by putting the oral medication bedaquiline first as a drug, the introduction of the new regime in India would be a difficult task for professionals and professionals Health activists.
In a move that could revolutionize the treatment of tuberculosis, WHO added the new oral drug, bedaquilin, to levofloxacin / moxifloxacin in Group A last week, making it the leading drug in the treatment of all MDR-TB. Previously, it had been included in “Group C”, which stated drugs that could be used “when group A and B agents can not be used”. Currently, MDR cases are treated with kanamycin and capreomycin injections, along with another group of medicines called fluoroquinolones. But this therapy has serious side effects like hearing loss and kidney disease. In addition, patients must visit a facility for six months every day for injections. All these factors often lead to a high termination of treatment.
In India, although the use of bedaquiline has increased in the last two years, it will only be given to patients with largely drug-resistant TB (XDR-TB), a rare type of MDR-TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs.
However, most state-owned hospitals and primary health centers currently lack facilities for additional testing, which are mandatory along with the introduction of bedaquiline. “Even with the revised WHO standards, most healthcare professionals will be reluctant to prescribe it for MDR-TB as the patient has to go through several additional surgeries, including BCG and the Drug Sensitivity Test (DST), as well as taking into account the physical condition of the patients, to see if they can handle potential toxicity as most of our TB patients are malnourished, we have skilled health professionals and nurses, but health centers lack the equipment and infrastructure to conduct such tests and careful monitoring said Qasim Sayyid of TB Alert India, a non-profit organization working with the government’s revised National Tuberculosis Control Program.