Abstract
India ranks highest in number of Tuberculosis (TB) and Multi Drug Resistant (MDR) TB patients globally (World Health Organization. Global tuberculosis report (2018). Maximum number of deaths due to TB also occur in India. A short course regime for treating Fluroquinolone (FQ) Sensitive MDR TB has been recommended by the World Health Organization (WHO) in 2020 with a duration of 9-11 months. India has also adopted the BDQ Short course regime for MDR-TB patients with multiple exclusion criteria. The excluded patients would receive a longer BDQ based regime which may last 18-20 months. The purpose of this mini-review is to emphasize the possibilities of high failure rates in the BDQ based short course regime, especially in the Context of India due to high baseline FQ resistance and an acute shortage of Drug Sensitivity Tests (DST) tests especially for FQ. Moreover, the need of High dose Isoniazid (Hh ) in the regime may be only a toxic addition in about 80% of patients leading to adverse effects, some of which may be fatal. Failure of BDQ-based short course regime would lead to a catastrophic amplification of the resistance of critically essential drugs such as BDQ and Clofazimine (CFZ). Chances of cure in such patients with Extensively Drug Resistant (XDR) TB would be slim, if not altogether absent.
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