16 Aug 2023 Drug-Resistant TB
This article covers “Daily Current Affairs” and the topic details “Drug-Resistant TB”. The topic “Drug-Resistant TB” has relevance in the “Science and Technology” section of the UPSC CSE exam.
For Prelims:
What is Tuberculosis (TB)?
What is DR TB?
For Mains:
GS3: Awareness in Health
Why in the news?
The formidable problem of drug-resistant tuberculosis (DR-TB) necessitates immediate and serious consideration. Given that India bears a quarter of the global burden of DR-TB cases, the way India responds could influence how other nations confront this escalating danger.
Tuberculosis (TB)
- Tuberculosis (TB) is an infectious disease caused by bacteria that are transmitted through the air from one person to another.
- While TB primarily affects the lungs, it can also target other body parts such as the brain, kidneys, or spine.
- While TB is generally treatable and can be cured, individuals with TB can face fatal outcomes if they are not provided with appropriate treatment.
Emergence of Drug-Resistant TB
- Occasionally, a more challenging form known as drug-resistant TB arises when the TB bacteria become immune to the drugs typically employed for TB treatment.
- This implies that the drugs are no longer effective in eradicating the TB bacteria.
Transmission of Drug-Resistant TB
- The transmission of drug-resistant TB occurs through the same methods as drug-susceptible TB.
- This airborne bacteria can be inhaled by people in close proximity, leading to infection.
Drug-Resistant Tuberculosis: Causes and Risk Factors
- Incomplete Treatment Courses: Individuals failing to complete the full prescribed course of TB treatment contribute to the development of drug-resistant strains.
- Inaccurate Prescription: Health care providers prescribing treatments with incorrect dosages or durations inadvertently foster the emergence of drug resistance.
- Unavailability of Proper Medications: A lack of access to appropriate TB drugs can hinder effective treatment, thereby enhancing the risk of drug-resistant TB.
- Quality of Drugs: Poor-quality drugs, characterized by substandard potency or formulation, can render TB treatment ineffective and potentially lead to drug resistance.
Types of DR- TB
- Multidrug-Resistant TB (MDR TB)
- Multidrug-resistant TB (MDR TB) arises from TB bacteria exhibiting resistance to two pivotal TB drugs: isoniazid and rifampin.
- These two drugs form the backbone of treatment for all individuals afflicted by TB disease.
- The consultation of TB experts is imperative when managing MDR TB cases
- Pre-Extensively Drug-Resistant TB (pre-XDR TB)
- Pre-Extensively Drug-Resistant TB (pre-XDR TB) constitutes a subset of MDR TB.
- It develops when TB bacteria display resistance to isoniazid, rifampin, and either a fluoroquinolone or a second-line injectable drug (such as amikacin, capreomycin, and kanamycin)
- Extensively Drug-Resistant TB (XDR TB)
- Extensively drug-resistant TB (XDR TB) represents a rare form of MDR TB with heightened resistance.
- TB bacteria in XDR TB cases are not only impervious to isoniazid and rifampin but also to a fluoroquinolone and a second-line injectable drug (like amikacin, capreomycin, and kanamycin).
- Alternatively, XDR TB can emerge when TB bacteria resist isoniazid, rifampin, a fluoroquinolone, and either bedaquiline or linezolid.
- Because XDR TB displays resistance against the most potent TB medications, patients confront treatment options of significantly diminished efficacy.
- Notably, individuals with compromised immune systems, particularly those with HIV infection or other immune-weakening conditions, face heightened vulnerability.
- Such individuals are not only more prone to developing TB disease post-infection but also encounter an elevated risk of mortality once the disease takes hold.
TB Situation in India
- The situation of multidrug/rifampicin resistant TB (MDR/RR-TB) in India is concerning. The WHO estimates around 119,000 new MDR/RR-TB cases emerge in India annually. However, in 2022, the Indian TB program reported only around 64,000 cases.
- India aims to eliminate TB by 2025, with targets like reducing new TB cases to 44 per lakh population, mortality to 3 deaths per lakh, and eliminating catastrophic costs.
Challenges in Achieving India’s TB Elimination Targets
- MDR-TB as a Major Hurdle:
- Rifampicin resistance is a significant concern, as it is the most effective first-line drug.
- Resistance to rifampicin and isoniazid is termed MDR-TB. Despite progress, DR-TB remains a public health threat in India.
- Divergence from WHO Recommendations:
- While WHO recommended the use of the BPaL regimen (Bedaquiline, Pretomanid, and Linezolid) for DR-TB patients, India has continued using a mix of treatment options, many of which are challenging to adhere to.
- The BPaL regimen has shown an 89% success rate, reduced pill burden, and shorter treatment duration.
- Reliance on Outdated Detection Methods:
- India continues to rely on traditional methods like sputum smear microscopy, which only detects half of all TB cases and cannot identify drug resistance.
- Molecular diagnostics, recommended by WHO, are more accurate and cost-effective.
- Private Sector Engagement: Scaling up private sector involvement is crucial, given their potential to improve treatment outcomes.
- High DR-TB Burden: DR-TB cases require expensive specialized drugs and prolonged treatment.
- Research and Cost Control: Lack of research and cost control measures hinder effective TB management.
- Undernutrition and Immunity: Undernourishment weakens immunity, leading to TB reactivation.
- Treatment Discontinuation: Limited resources and financial constraints cause many to abandon treatment midway.
- Drivers of TB Epidemic: Delayed diagnosis, inadequate treatment, high recurrence rates, drug resistance, comorbidities (diabetes, HIV), and urbanisation contribute to the ongoing TB crisis.
Achievements and Path Forward
- Enhanced Diagnosis: Rapid molecular diagnostics, akin to those used during the COVID-19 pandemic, aid in rapid TB detection.
- Reduced DR-TB Treatment Duration: Shortened treatment duration (from 24 to 6 months) with oral medications, avoiding painful injections.
- Recommended BPaL Regimen: Shifting to the WHO-recommended BPaL regimen promises higher success rates and substantial cost savings.
- Availability of New Tools: Accurate diagnostic tools can facilitate the cure of DR-TB within six months using oral medications.
Advancing TB Management in India
- Access to optimal diagnostic and treatment options is a fundamental right. Leveraging advanced tools is essential to prevent suffering and deaths due to drug-resistant TB.
- India’s adoption of the WHO-recommended BPaL regimen, wider implementation of accurate diagnostics, and continued efforts are pivotal to achieving the ambitious goal of TB elimination by 2025.
Sources:
India’s TB problem and the right to treatment | The Indian Express
Yojna daily current affairs eng med 16th August 2023
Q1. With reference to Tuberculosis, consider the following statements:
- Tuberculosis (TB) is caused by a virus that spreads through the air from person to person.
- TB can affect various body parts beyond the lungs, such as the brain, kidneys, or spine.
- Drug-resistant TB can occur when the TB bacteria develop immunity to commonly used drugs.
Which of the statements given above is/are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 3 only
(d) None
Answer: (b)
Q2. Consider the following :
- Poor-quality drugs, characterised by substandard potency or formulation, can render TB treatment ineffective and potentially lead to drug resistance.
- Multidrug-resistant TB (MDR TB) develops when TB bacteria become resistant to the second line of drugs.
- Isoniazid and rifampin are among the primary drugs used for initial treatment.
How many of the above mentioned statements are correct ?
(a) Only one
(b) Only two
(c) All three
(d) None
Answer: (b)
Q3. What does the term “drug-resistant tuberculosis (DR-TB)” refer to, and why is it considered a pressing concern? How can India’s response to the issue of drug-resistant tuberculosis influence the global approach to this problem?
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