Tuberculosis Without a Cure: TDR or XDR?

There is an overwhelming number of acronyms for the various forms of tuberculosis, and some debate about which strain coincides with what acronym. The discussion over semantics, however, should not overshadow the fact that TB drug resistance is rapidly increasing.

Although the WHO prefers to call the newest outbreak of TB resistant cases Extremely Drug Resistant (XDR+), doctors at the National Institute for Research and Tuberculosis (NIRT) in Chennai maintain the dozens of cases they have seen since July were Totally Drug Resistant (TDR). This means that none of the existing 12 antibiotics used to treat tuberculosis were effective. 

Patients suffering from this lethal strain are left with few options. Dr. Zarir Udwadia, who first spoke about TDR-TB in Mumbai earlier this year says, “We have little to offer these patients except for drastic surgery and medication for relief.”

Though many doctors in India have clinically confirmed the existence of TDR-TB, some debate over its existence remains because it is difficult to prove in the lab. Once further research on the strain’s drug resistance is conducted, other groups may be willing to accept the doctors’ definition.

Additional cases of TDR-TB have also been reported in Bangalore, New Delhi, and in far-off Italy. A nationwide survey to determine the incidence of this highly resistant strain is planned to begin in India by the end of 2012, and will provide interested parties with more comprehensive figures of the epidemic.

Tuberculosis remains a disease of poverty; disproportionately affected developing countries where poor access to health services, unsanitary living conditions, and overcrowding fuel the epidemic. Tuberculosis drugs are very expensive, and most individuals are unable to pay the exorbitant price without some financial aid. Unfortunately, second line drugs used to treat multi drug-resistant TB (MDR-TB) are even costlier. Further, individuals who do not have access to the complete drug regimen are more vulnerable to developing drug resistance, which is easily spread from person-to-person.

India continues to have the highest incidence of TB cases by contributing one-fifth, approximately 2 million individuals, of the global TB cases annually. Although great strides have been made in tuberculosis treatment and control, with the advent of this new “superbug,” it seems essential that India revisit its tuberculosis strategy to include approaches not currently covered by the government-implemented TB program.

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