State shifts to daily drug regimen for TB patients

With the deadline to eliminate tuberculosis set for 2025, under the national strategic plan by the Central Tuberculosis Division, Karnataka has moved from the intermittent drug regimen (thrice a week) to daily regimen of TB drugs. The new regimen under the Revised National Tuberculosis Control Programme (RNTCP) is in the wake of evidence of high relapse rates under the intermittent drug regimen. In January this year, the Supreme Court also directed the Union Health Ministry to replace the thrice-a-week treatment regimen with a daily dosage “to curb relapse and deaths during treatment.” Fixed combination Under the new daily drug regimen, TB patients will be given fixed drug combinations (FDCs) — three or four drugs in specific dosages in a single pill — on a daily basis. The drugs will also be administered in a more scientific manner according to the patient’s weight. “The biggest advantage for the patient under the new regimen will be reduced pill burden, as instead of seven tablets, patients need consume only 2 or 3 tablets, according to his weight band,” State Joint Director (TB) R. Raghunandan told The Hindu. The Central TB Division already implemented this shift in treatment strategy for drug sensitive TB patients in Himachal Pradesh, Sikkim, Bihar, Maharashtra and Kerala last year. “All drug procurement logistics and trainings have been completed and the new regimen that was formally inaugurated on October 13 has already taken off in a few districts,” he said. Although from the beginning, patients under the RNTCP were being administered drugs thrice a week in government hospitals, private sector physicians who handle a considerable number of TB cases have been treating their patients on a daily regimen of tailor-made drug combinations and dosages. Ravindra Mehta, Consultant Pulmonologist, Apollo Hospitals, said the intermittent drug regimen was actually based on the convenience of patients. “But, this total variance in treatment practices and innumerable drug combinations have only encouraged drug resistance and relapse apart from a high default rate in treatment. Following this, the World Health Organisation revised its TB management guidelines in 2010, recommending that the daily drug regimen be adopted under RNTCP,” he said. Karnataka’s burden Although the Union Health Ministry’s revised estimates put the incidence of TB in India at 217 cases per one lakh population in 2015, Karnataka is struggling to detect 101 cases per one lakh population a year. This shows that the State has a long way to go in identifying TB cases, which according to sources, are either going undiagnosed, unreached, or being treated by private doctors without notifying or are even lost to follow up. According to officials, the new regimen is likely to result in quality treatment of patients. “There will be better surveillance and patient support system irrespective of the sector (public or private) where they are being treated,” said sources.