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Super Tb: Another manmade disaster

Resistant tuberculosis is aman made disaster due to negligence of patients, physicians, and policy makers. It has been fuelled by inadequate use of sputum smear microscopy, excessive dependence on chest radiography, illogical manufacture and irrational prescription of improper combinations of medicines, inadequate dose,duration and noncompliance to the prescribed treatment. The resultant gift is the dreaded Totally Drug Resistant Tuberculosis (TDR-TB). Culture and drug sensitivity testing (DST) should not blindly direct the management of TDR-TB, but has the importance in individualising the drug therapy in TDR-TB patients.The DST which is a crucial part of Directly Observed Treatment Short course (DOTS) plus has been introduced in a phased manner in India. However measuring resistance to second line anti-tubercular drugs (SLDs) with DST is complex and lacks standardization. The WHO has categorized the SLDs based on their efficacy. Most of the DST methods have a turnaround time of several months and empirical regimen should be switched to individual regimen depending on DST results. Newer assays like microscopic observation drug susceptibility assay,line-probe assay and bacteriophage assay can be used for rapid detection of drug resistance. Pharmacovigilanceis urgently needed for resistant tuberculosis as SLDs are less efficacious and more toxic. Presently, the treatment of TDR-TB is not consolidated. Precaution in the treatment, prevention of spread of the infected cases and use of newer vaccines are some of the strategies which have to be used to contain the new mighty variant of microbe mycobacterium tuberculosis.