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Sir,

24th March - being World Anti TB Day following would be useful to readers of Bombay Hospital Journal.

* Tuberculosis is known for more than 100 years.

* Effective treatment is known for more than 50 years.

Unfortunately

* Incidence of tuberculosis has not decreased in our country.

* Total number of the patients have increased.

To add fuel to the fire

* Incidence of MDR (Multi drug resistance) TB is increasing very fast.

* With increase in HIV and diabetes, TB is bound to increase.

Statistics like one person dies every minute and 5 to 7 new are added is known to you.

What can a practising doctor do?

1. Prescribe correct treatment.

2. Ensure that the patient completes the course of treatment.

Ask yourself :

1. Regimen : Do you select drug regimen on the basis of fresh case/retreatment case? In retreatment case because of high acquired drug resistance the regimen is different (5-6 drugs initially for 3 months and 3-4 drugs in maintenance phase for 6-9 months).

2. Doses : Do you give doses as per body weight of the patients? You cannot give the same doses to 35 kg body weight and 70 kg body weight patients. Inadequate doses may produce resistance. Higher doses will produce toxicity.

3. When you prescribe FDC (Fixed drug combination) tablets containing 3-4 drugs, do you ensure that the patient takes the full dose together and does not decrease the number or split the dose for his convenience and tolerance? With such practice MIC (minimum inhibitory concentration) will not be achieved and one may develop resistance.

4. Do you give Rifampicin on empty stomach? If Rifampicin is taken with food only 50% will be absorbed. This will give low MIC and subsequent resistance.

5. Do you add 2-3 new drugs to a failing regimen? If a regimen is failing, there is resistance to most of these drugs. If you add single drug, this will be monotherapy and the new drug will soon develop resistance.

6. Because of poor understanding of the resistant regimens on many occasions we make the patients incurable by prescribing wrong MDR regimens. This should be avoided.

7. Majority of TB patients stop treatment prematurely and develop resistance subsequently. This is because of lack of information and lack of money. Do you give all your patients literature on TB or give adequate information and do you direct poor TB patients where the TB treatment is available free or at concessional rate?

It is only we who can get rid of TB from our country

Dr. Sunil V Shah

Consulting Chest Physician

Malad, Mumbai.