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Study picks up holes in Category IV MDR-TB treatment

As per the WHO guidelines, the intensive phase of a treatment regimen for MDR-TB should include at least four second-line anti-TB drugs that are likely to be effective.

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A new study conducted by PD Hinduja Hospital and published in Lung India's latest May-June edition says that local epidemiology and prevalent drug-resistant patterns should be considered while designing an empiric regimen to avoid amplification of resistance. This study picked up a hole in the government's standardised Category IV treatment regimen for multidrug-resistant tuberculosis (MDR-TB) patients.

The hospital's study was aimed at analysing the impact of prescribing the standarised Category IV regimen to all their patients receiving a drug susceptibility at their mycobacteriology laboratory. According to the study, a high proportion of patients were found to have resistance to a number of the first and second-line drugs and the standarised regimens were not effective for all patients. As of 2013, about 2,610 patients were on Category IV treatment in Mumbai itself.

As per the WHO guidelines, the intensive phase of a treatment regimen for MDR-TB should include at least four second-line anti-TB drugs that are likely to be effective.

Reacting to the study, a doctor from the health department of Brihanmumbai Municipal Corporation said that the Centre has initialised individual treatment for tuberculosis management in public sector. "The Centre has ordained a drug sensitivity test for new TB patients before starting their treatment. This is a pilot project and Mumbai will be a part of it. Currently, in Mumbai, it is done only for certain categories like children, HIV patients, and close contact people of drug resistant TB patients testing positive for TB," said the doctor.

Toxic drugs for longer durations

The study pointed out that the treatment regimens for MDR-TB involve weaker and more toxic drugs for longer durations. It also said that the cure rates with these regimens vary from 38% to 100% in different studies. The study said that while standarised regimens are not effective for all patients, individualised treatments have shown to reduce amplification of resistance.

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