India: TB Resistance and Challenges

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The page below is a sample from the LabCE course Tracking Antibiotic-Resistant Tuberculosis. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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India: TB Resistance and Challenges

According to the 2016 World Health Organization (WHO) data, the number of TB cases in India (2.79 million infected) far exceeded that of any country in the world.
  • More than 100,000 of these cases were caused by drug-resistant strains that continuously mutated into more resistant forms, which comprised at least 20% of multidrug-resistant tuberculosis (MDR-TB) cases globally.
  • In the past, cases treated in India's private sector did not require government notification and TB statistics have been considered under-reported. Recent engagement with these providers by public health experts has prompted the standardization of reporting.
MDR-TB first appeared in the 1990s and was followed by cases of extensively drug-resistant tuberculosis (XDR-TB) at Mumbai’s Hinduja Hospital and Research Center in 2006. A report of totally drug-resistant tuberculosis came from Italy in 2007; then came reports of 15 similar patients from Iran in 2009. Zarir Udwadia, MD, director of the Hinduja National Hospital in Mumbai, published four cases of Indian patients, which added to the total of twelve assumed TDR-TB cases by 2012.
These cases were noted as totally resistant to all the available anti-TB drugs (e.g., first- and second-line anti-TB therapy), as described by Dr. Udwadia in correspondence to the journals Clinical Infectious Diseases and Respirology.
  • The patients had received unsupervised treatment for MDR-TB with second-line drugs, added separately, often with incorrect dosages, for periods of 18 months.
  • Dr. Udwadia reported that the appearance of these totally resistant strains resulted from selective resistance (by the bacillus) to incorrect antibiotic treatment/dosage and poor follow-up of the patient’s previous MDR- and XDR-TB. They had failed two standard treatment programs through public health programs, then were subjected to inappropriate treatment by private physicians for another year before they were seen at Hinduja Hospital, where they received salvage or experimental drugs and in some cases, surgical removal of a lung.