Dear Editor,
We recently read the editorial that was published in your journal with the title “New treatments for Drug Resistant TB: Past imperfect, future bright” where authors did a good job of conveying the scenario of tuberculosis treatment in India at the moment. The authors also addressed the existing options for managing drug-resistant TB. We would like to contribute to this discussion as well.[1]
It is a well-known fact that is the most lethal infectious illness in the world and has a high death rate. Drug-resistant tuberculosis is classified by the World Health Organization (WHO) into categories, including multi-drug resistant (MDR), pre-extensive drug resistant (Pre XDR), extensive drug resistant (XDR), and total drug resistant (TDR). The WHO and our government have set 2030 as the goal year for the elimination of tuberculosis, but the COVID-19 pandemic may hamper us from achieving this goal.[2] With the assistance of the central government and WHO, a number of programs are in operation, include End TB, End TB-Q, TB PRACTECAL, and many others. Several projects are working on three key medications as the final treatment options for drug-resistant tuberculosis. Those 3 drugs are Bedaquiline, linezolid, and delamanid.[3]
The number of MDR and XDR tuberculosis cases grew (6.4%) from 156982 to 166991, according to the global tuberculosis report. These figures show population trends that are raising resistance. To treat XDR and TDR tuberculosis, we had these three medications, but we weren’t sure how those patients would respond to them. Bedaquiline use to treat XDR tuberculosis was started from long ago and their resistance also reported, while Linezolid use to treat gram positive organisms too.[4,5] Due to oral form availability of the Linezolid, it is frequently used to treat Methicillin-resistant Staphylococcus aureus, Coagulase-negative Staphylococcus species, and Enterococcus species, but patients can also be treated with Vancomycin in parental form.[6] As a reserve drug, this kind of clinical practice needs to end in order to prevent their resistance. Otherwise, we eventually lose the final medicine in our category for the tuberculosis treatment protocol.
Few first- and second-line tuberculosis medications are reserve drugs and cannot be used by common men, according to our national tuberculosis treatment standards. The only way to obtain certain medications is through physicians and DOTS personnel. Why couldn’t we keep all three of the last resources drugs as backup medications if we can produce first line and second line medications? In addition, risk factor reduction must be a priority rather than only looking for new drug regimens. We must educate patients and other populations about the risk factors that contribute to the development of drug-resistant tuberculosis in order to completely eliminate Tuberculosis.
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REFERENCES
1. Udwadia ZF, Patel JM. New treatments for drug resistant TB:Past imperfect, future bright. Lung India 2023;40:1–3.
2. Global tuberculosis report 2022 Geneva World Health Organization 2022 Licence:CC BY-NC-SA 3.0 IGO.
3. TB PRACTECAL |MSF UK n.d Available from:
https://msf.org.uk/tb-practecal [Last accessed on 2023 Jan 12].
4. Padmapriyadarsini C, Vohra V, Bhatnagar A, Solanki R, Sridhar R, Anande L, et al. Bedaquiline, delamanid, linezolid and clofazimine for treatment of pre-extensively drug-resistant tuberculosis. Clin Infect Dis 2022;76:e938–46.
5. Chesov E, Chesov D, Mourer F, Andres S, Utpatel C, Barilar I, et al. Emergence of bedaquiline resistance in a high tuberculosis burden country. Eur Respir J 2022;59:2100621.
6. Hashemian SMR, Farhadi T, Ganjparvar M. Linezolid:A review of its properties, function, and use in critical care. Drug Des Devel Ther 2018;12:1759–67.
