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Drug resistant TB

TB is a bacterial disease which in humans is usually caused by an organism called Mycobacterium tuberculosis (M. tuberculosis)

Some people are known to have a higher risk of becoming ill.

These include:

  • Infants and children aged less than 4 years
  • People infected within the previous two years
  • People infected with HIV
  • People who have certain illnesses or conditions which affect their immune system, such as people with diabetes, and people with chronic renal failure.

 Drug-resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.

Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Examples of misuse or mismanagement include

  • People do not complete a full course of TB treatmen
  • Health care providers prescribe the wrong treatment (the wrong dose or length of time
  • Drugs for proper treatment are not available
  • Drugs are of poor quality

 XDR-TB involves resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin, also known as multidrug-resistance (MDR-TB), in addition to resistance to any of the fluoroquinolones (such as levofloxacin or moxifloxacin) and to at least one of the three injectable second-line drugs (amikacin, capreomycin or kanamycin).

People may get XDR-TB in one of two ways. It may develop in a patient who is receiving treatment for active TB, when anti-TB drugs are misused or mismanaged, and is usually a sign of inadequate clinical care or drug management. It can happen when patients are not properly supported to complete their full course of treatment; when health-care providers prescribe the wrong treatment, or the wrong dose, or for too short a period of time; when the supply of drugs to the clinics dispensing drugs is erratic; or when the drugs are of poor quality. The second way that people can develop XDR-TB is by becoming infected from a patient who is already ill with the condition. Patients with TB of the lungs can spread the disease by coughing, sneezing, or simply talking. 

 Solutions to control drug-resistant TB are to:

  • Cure the TB patient the first time around
  • Provide access to diagnosis
  • Ensure adequate infection control in facilities where patients are treated
  • Ensure the appropriate use of recommended second-line drugs.

 Practice questions:

  1. Which of the following is/are the benefits of DOTS?
  1. More than doubles the accuracy of TB diagnosis.
  2. It prevents the spread of tuberculosis by prioritizing sputum positive patients for diagnosis and treatment, thus reducing the incidence and prevalence of TB.
  3. It prevents treatment failure and the emergence of MDR-TB by ensuring patient adherence to treatment and uninterrupted supply of anti -TB drugs.

Codes:

  1. i and ii
  2. ii only
  3. i and iii
  4. all

ans: d

exp: Tuberculosis is completely curable through short-course chemotherapy. Treating TB cases who are sputum-smear positive (and who can therefore spread the disease to others) at the source, it is the most effective means of eliminating TB from a population.

DOTS or Directly Observed Treatment Short course is the internationally recommended strategy for TB control that has been recognized as a highly efficient and cost-effective strategy. DOTS comprises five components.

  • Sustained political and financial committment. TB can be cured and the epidemic reversed if adequate resources and administrative support for TB control are provided
  • Diagnosis by quality ensured sputum-smear microscopy. Chest symptomatics examined this way helps to reliably find infectious patients
  • Standardized short-course anti-TB treatment (SCC) given under direct and supportive observation (DOT).Helps to ensure the right drugs are taken at the right time for the full duration of treatment.
  • A regular, uninterrupted supply of high quality anti-TB drugs. Ensures that a credible national TB programme does not have to turn anyone away.
  • Standardized recording and reporting. Helps to keep track of each individual patient and to monitor overall programme performance
  1. To monitor Revised National Tuberculosis Programme (RNTCP) effectively which of the following a web enabled and case based monitoring application has been launched?
  1. ANMOL
  2. E-RaktKosh initiative
  3. E-Nikshay
  4. Saathiya Salah

Ans: c

NIKSHAY is a web based solution for monitoring of TB patients To monitor Revised National Tuberculosis Programme (RNTCP) effectively, a web enabled and case based monitoring application called NIKSHAY has been developed by National Informatics Centre (NIC). This is used by health functionaries at various levels across the country in association with Central TB Division (CTD), Ministry of Health & Family Welfare. NIKSHAY covers various aspects of controlling TB using technological innovations. Apart from web based technology, SMS services have been used effectively for communication with patients and monitoring the programme on day to day basis.

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