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More evidence needed for acute types: WHO

United Nations’ body does not endorse extremely drug-resistant (XXDR-TB) and TDR.

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Alifiya Khan
While the scare of suspected extensively drug-resistant tuberculosis (XXDR-TB) cases rocks Mumbai and the rest of the state forcing the authorities to step up surveillance on TB, experts at a conference of World Health Organization (WHO) said more evidence and better diagnosis is needed before redefining the disease.
Stating clearly that currently only two definitions exists for drug-resistant TB — multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB — they said terms such as extremely drug-resistant (XXDR-TB) and totally drug-resistant (TDR) were coined after researchers found few stray cases in Iran and India of patients not responding to all-known TB drugs.
A WHO press release said that current evidence was insufficient to adopt new case definitions for drug-resistant TB. It further stated that drug susceptibility testing (DST), which is the key to defining new levels of drug resistance, lacks accuracy for several of the drugs that are used to treat MDR and (XDR)-TB.
The release further stated that there is insufficient correlation of DST results with clinical response to treatment for several drugs currently used to treat XDR-TB and new drugs are undergoing clinical trials.
The experts urged diagnostic companies and TB laboratories to develop better diagnostic tests.
Chest physician Dr Nitin Abhyankar said he agreed with the WHO experts. “Currently we declare TDR or XXDR-TB based on lab testing where drug susceptibility to all-known TB drugs is zero. However, in clinical practice we are yet to see a single case where patient doesn’t respond to a single drug. There is a difference in lab tests and what we see in actual practice and hence their surmise that we lack evidence to say TDR or XXDR is absolutely correct,” said Abhyankar.
TB expert Dr Mahavir Modi too agreed that no such term was published and it was unknown if TDR-TB cases actually exists.
However, Maharashtra’s anti-TB association’s secretary and technical advisor Dr Yatin Dholakia doesn’t agree with the WHO decision. “The fact remains that these patients are resistant to the available drugs to treat TB. What else should we call these people? Instead of wasting energy and money on holding meetings on the definition of the drug resistant form of TB, the authorities should channelise the energy and money in
treatment options for such people.”
(With inputs from Somita Pal)

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