'Totally' Resistant TB Surfaces in India

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Drug resistance in tuberculosis appears to have reached a peak in several patients in India, who are virtually untreatable with available medications.

In a letter to Clinical Infectious Diseases, published online, Mumbai physicians described four patients whose TB was resistant to five front-line drugs and seven second-line medications.

They are “totally drug-resistant,” according to Zarir Udwadia, MD, and colleagues at P. D. Hinduja National Hospital and Medical Research Centre in Mumbai.

Udwadia and colleagues blamed the rise of such resistance on India’s healthcare system, which has had some success against normal TB, but which they said does not pay enough attention to resistant strains.

As a result, many patients with resistant TB go to private physicians who are “unregulated both in terms of prescribing practice and qualifications,” they said.

The result is inadequate care that leads to increasing resistance, rather than cure, they argued.

The emergence of resistance to all available TB drugs “is not surprising,” according to Kenneth Castro, MD, director of the CDC’s Division of Tuberculosis Elimination.

The four patients are the first in a series of 12 cases that have emerged since doctors at the institution began grappling with “increasingly resistant strains of tuberculosis” a few years ago, Udwadia and colleagues reported.

TB treatment is usually relatively easy — the bacterium in most cases succumbs to a regimen consisting of isoniazid (Nydrazid), rifampin (Rifadin), ethambutol (Myambutol), and pyrazinamide for eight weeks, followed by isoniazid and rifampin for another 18 weeks.

Source : http://www.medpagetoday.com