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Experts: Drug-resistant cases need more proof

The World Health Organisation (WHO) experts said more evidence and better diagnosis were needed before redefining the drug-resistant tuberculosis cases found by PD Hinduja Hospital in January.

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The World Health Organisation (WHO) experts said more evidence and better diagnosis were needed before redefining the drug-resistant tuberculosis cases found by PD Hinduja Hospital in January.

Experts met in Geneva, WHO’s headquarters, on March 21-22 to discuss naming the TB strain found by the city hospital.  They said there were only two definitions for drug-resistant TB — multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB. And that extremely drug-resistant (XXDR-TB) and totally drug-resistant (TDR) were terms coined after researchers found few stray cases in Iran and India of patients not responding to known TB drugs.

The WHO’s press release said there was insufficient evidence to adopt new case definitions for drug-resistant TB. Drug susceptibility testing (DST), the key to defining new level of drug resistance, lacks accuracy for many drugs used to treat MDR and XDR-TB.

There was insufficient correlation of DST results with clinical response to treatment for several drugs used to treat XDR-TB and new drugs are undergoing clinical trials, and could prove effective against drug-resistant strains.

The meeting urged TB laboratories to develop better diagnostic tests and agreed that WHO and technical partners should develop detailed guidance on XDR-TB treatment.

The experts said the emergence of drug resistance should be a wake-up call for ministries of health. The group urged the global TB community to scale up provision of care and management to avoid a scenario where TB becomes incurable.

Dr Jaisingh Phadtare, the head of the department of chest diseases at Grant Medical College said: “Calling the drug-resistant TB strain total drug resistant brings us to the end of road. In this era when there is so much development happening at the scientific front, we can’t give up hope.”

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