Indian Express
05 June 2010
By Anuradha Mascarenhas

Hospital has a paucity of drugs for treating Multi Drug Resistant tuberculosis
AT Sassoon General Hospital’s tuberculosis ward, doctors have no other option but to direct patients to the private sector due to paucity of drugs for treating Multi Drug Resistant tuberculosis (MDRTB). ‘‘This is a 24 month-long treatment programme and the cost of the treatment for each patient is over Rs one lakh,’’says Dr S V Ghorpade, head of the department of TB at Sassoon General hospital.

The tablets are extremely expensive and we can only admit those patients who can afford treatment after being discharged from the hospital, says Ghorpade who has sent several letters to the state government for the better management of MDR TB patients. The supply of drugs is inadequate and there is already a waiting list of 25 MDR TB patients.

"On a daily basis, there are 60 – 70 patients at the Out Patient Department of TB and on a monthly basis we see at least 5-6 patients who have developed multi drug resistance to TB," said Ghorpade. Dr Dilip Jagtap, who is assistant medical officer of health and incharge of the national health programmes at the Pune Municipal Corporation (PMC, and also the head of the city TB control unit points out that a patient with MDR – TB requires six seven different types of medicines.

"There are 900–1,000 cases of different kinds of TB that are diagnosed every three months at the PMC dispensaries. While 300 are new patients of TBwe see 70–80 MDR –TB patients in a year," says Jagtap. He admitted that they have to deal with the problem of availability of drugs.

While the government has plans to set up a laboratory to detect MDR-TB cases, it will be only after another six months that it will be fully functional at Aundh. Dr Kanchan Jagtap, director of the state TB Demonstration Centre at Aundh said their role presently was to train medical officers and laboratory technicians in how to handle and manage MDRTB patients. The accreditation of the laboratory will take another six months and it will be functional only after November, says Jagtap.

MDRTB caused by myobacterium tuberculosis is resistant to both isoniazid and rifampicin and is a phenomenon that is threatening to destabilize global TB control.

While newer and effective anti–TB drugs are still to be made available, the government now plans to expand the Directly Observed Short Treatment (DOTS) -Plus programme to ten states for the management of MDRTB patients. When contacted Dr Sandeep Bharswadkar, technical consultant to Indian Medical Association for TB said that the DOTS Plus programme where the government would provide drugs for 24 months is being introduced in a phased manner in the state. Nagpur, Akola and Mumbai divisions have started the DOTS Plus programme and it will soon be introduced in the Pune division, he said.