Drug-resistant Tuberculosis In India Research Articles

A critical review of risk factors influencing the prevalence of extensive drug-resistant tuberculosis in India.

Globally, extensive drug-resistant tuberculosis (XDR-TB) is a major element to cause morbidity and death among tuberculosis patients. The present study identifies the vital risk variables contributing to XDR-TB prevalence in India. Scopus, PubMed/Medline, Science Direct, and Google Scholar databases were searched thoroughly for the articles, using medical subject heading as a key term published between the years 2012 and 2022. According to the inclusion criteria, 11 publications were selected. Socioeconomic characteristics include employment, educational attainment, undernourishment, and the rest, and demographic factors such as gender, age, and more. Were examined in the review, whereas alcoholics, smoking, and diabetes mellitus were investigated under comorbidities and behavioral risk factors. We observed that noncompliance, poor knowledge, and insufficient health-care facilities could significantly accelerate the spread of XDR-TB, and the present review imparts a remarkable and detailed evaluation of XDR-TB. The study analysis is markedly useful for policymakers as well as researchers to discover and implement effective solutions for tuberculosis-infected patients.

Adverse drug reactions due to linezolid in the programmatic management of drug-resistant tuberculosis in India: A retrospective multicenter study

BackgroundMonitoring and managing adverse drug reactions (ADR) are critical for treating drug-resistant tuberculosis (TB). ObjectiveTo study symptomatic, linezolid-attributable ADRs in TB patients initiated on all oral longer bedaquiline-based treatment regime for multidrug-resistant/rifampicin-resistant (MDR/RR)-TB under programmatic conditions. MethodsIt was a multicenter, retrospective study of people with MDR/RR-TB in nine TB units in Nagpur, India, from March 2020 to April 2022. ResultsThe study consisted of a sample size of 106 individuals with multidrug-resistant and rifampicin-resistant tuberculosis out of a total of 110 individuals with the disease. Of these, 45 (42.45%) experienced linezolid ADRs, with an incidence of 11.37 cases per 1000 person-weeks. These patients were significantly younger (31.24 ± 11.13 years) and more likely to be female (27, 50%) than those without ADRs. ADR severity was mild in 20 (44.45%), moderate in 15 (33.33%), and severe in 10 (22.22%) patients. The most common ADR was peripheral neuropathy (42, 93.33%), followed by lactic acidosis (3, 6.67%), anemia (2, 4.44%), and optic neuritis (2, 4.44%). Dosing was reduced in 17 (37.78%) patients, and linezolid was withdrawn entirely in 19 (42.22%) patients. Only 9 (20%) patients continued linezolid unmodified. For mild to moderate linezolid-associated symptomatic peripheral neuropathy, symptom management with or without dose reduction is an effective strategy; however, immediate linezolid withdrawal is necessary in severe or life-threatening peripheral neuropathy cases. After a mean follow-up of 41 ± 21.33 weeks, ADR symptoms resolved completely in 4 (6.67%) patients and decreased in 42 (93.33%) patients. ConclusionLinezolid ADRs, often neuropathy, frequently occur in patients on an all-oral bedaquiline-based treatment regime for MDR/RR-TB. Women and younger patients are more likely to experience these ADRs, usually mild to moderate in severity. Management of symptomatic linezolid-associated peripheral neuropathy should be based on ADR severity. These ADRs often affect linezolid dosing, so it is important to identify and manage them early.

A Case Report of Drug Resistant Tuberculosis Involving Brain

We report a 21 year old male resident of Tasgaon, Maharashtra who was diagnosed with drug resistant tuberculosis affecting his lungs and brain, resistant to first line antitubercular drug Rifampicin. Initially he was diagnosed as a case of extrapulmonary tuberculosis, left sided tubercular pleural effusion. Later during course of treatment he developed central nervous system tuberculosis confirmed on magnetic resonance imaging brain contrast study and Cerebrospinal fluid study. Cerebrospinal fluid catridge based nucleic acid amplification test showed Rifampicin resistance. He was started on Modified longer oral Multidrug/extensively drug resistant tuberculosis regimen according to Programmatic management of drug resistant tuberculosis in India, 2021 guidelines. Keywords: Tuberculosis, Extra pulmonary, Programmatic management of drug resistance, Oral regimen, Central nervous system tuberculosis

Recent changes in guidelines on programmatic management of drug resistant tuberculosis in India 2019: a paradigm shift in tuberculosis control

The new version of guidelines of programmatic management of drug resistant tuberculosis in India 2019 by Revised National Tuberculosis Control Programme, Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, integrates use of the shorter MDR TB regimen and all oral longer MDR TB regimen with new drugs under RNTCP with opportunity to modify the regimen based on DST results. There are mammoth and comprehensive changes in the guidelines on programmatic management of drug resistant tuberculosis in India 2019.

Effectiveness and safety of bedaquiline under conditional access program for treatment of drug-resistant tuberculosis in India: An interim analysis

BackgroundIndia accounts for a quarter of the world's multidrug-resistant tuberculosis (MDR-TB); with less than 50% having successful treatment outcomes. Bedaquiline (BDQ) was approved for use under conditional access program in India in 2015. ObjectiveWe evaluate the effectiveness, safety, and tolerability of a BDQ containing regimen used under field settings in India. MethodInterim analysis of a prospective cohort of MDR-TB patients on a BDQ containing regimen at six sites in the country. ResultsSix hundred and twenty MDR-TB patients [349 (56%) males; 554 (89%) between 18 and 50 years and 240 (39%) severely malnourished] were started on BDQ containing regimen between June 2016 and August 2017. There 354 (57%) patients had MDR-TB with additional drug resistance to fluoroquinolone (MDRFQ); 31 (5%) with additional resistance to second-line injectable (MDRSLI) and 101 (16%) extensively drug-resistant TB. After 6 months of treatment, culture conversion was achieved in 513 of 620 (83%) patients. The median time to culture conversion was 60 days. Higher body mass index was the only factor associated with faster culture conversion (HR 1.97; 95% CI 1.24–2.9). Around 100 patients (16.3%) experienced a ≥60-ms increase in QTc interval during the treatment. Seventy-three (12%) deaths were reported, the majority of them (56%) occurring within the first 6 months of treatment. ConclusionsBDQ with a background regimen has the potential to achieve higher and faster culture conversion rates with a lower toxicity profile among DR-TB patients. Use of BDQ with additional monitoring may be safe and effective even in the field settings.

1784. Impact of a Novel Multidisciplinary Anti-Tubercular Stewardship Program in a Tertiary Care Center in India

BackgroundInaccurate diagnosis of tuberculosis (TB) and inappropriate anti- tubercular therapy (ATT) contribute majorly to the emergence of drug-resistant TB in India, particularly in the private healthcare sector. Our study evaluated the appropriateness of ATT as per Revised National TB control Program at our institution, a large private tertiary center in Kerala, India, after establishment of an Anti-Tubercular Stewardship program (ATTSP).MethodsThe ATTSP was implemented as part of a recently developed Antimicrobial Stewardship Program (ASP). A multidisciplinary team including an administrative physician champion, pulmonologist, infectious disease specialist, and clinical pharmacists met twice weekly to review all patients initiated on ATT and to assess each case for appropriateness in terms of right indication, right drug, right dose, right frequency, and right duration. For each patient who had an inappropriate ATT prescription, appropriate recommendations based on standard treatment guidelines were filed in the charts and communicated to the primary team via email and phone. Compliance to recommendations was monitored. The clinical pharmacists followed up patients after dischargeResultsEight (52%) patients were prescribed ATT appropriately among the 153 patients reviewed from July 2017 to April 2018. Ninety-six interventions were recommended for the 73 cases with inappropriate ATT. Of these inappropriate ATT, 16 were for wrong indication, 27 for wrong drug, 52 for wrong dose and 1 for wrong frequency. Among the 137 accurately diagnosed cases of TB, 52% (71) were definite cases of TB while the rest were presumptive. Pulmonary, extra pulmonary and disseminated TB cases accounted for 45% (62), 50% (69) and 4% (6), respectively. ATT was appropriate in 63% (39) of pulmonary TB, and 54% (37) of extra pulmonary TB.Among 23 pulmonary TB patients with inappropriate ATT, 48% (11) were for wrong drug, 78%(8) for wrong dose and 17%(4) for wrong frequency. The 32 inappropriate extra-pulmonary TB cases included 19% (6) for inappropriate drug selection and 81% (26) for inappropriate dose. Compliance to ATTSP recommendations was 34%.ConclusionTB in India is a vital target for ATT stewardship (10% of patients in this cohort had an inaccurate diagnosis of TB). ATTSP may be a worth initial target for novel ASPs in India.Disclosures K. Kaye, Zavante Therapeutics, Inc.: Scientific Advisor, Consulting fee.

Extensively Drug-Resistant Tuberculosis in India: Prevalence, Incidence and Burden

Extensively Drug-Resistant Tuberculosis (XDR-TB) is a recent challenge for tuberculosis control program. The absence of the functional drugs and high rate of the failure in treatment and mortality rate also high jeopardize for epidemiology. Its prevalence is unknown in India as there was no nationwide counselling. Globally, there were an estimated 55,100 new extensively drug resistant tuberculosis cases in the year of 2015 in 117 countries. However, only 30 cases extensively drug-resistant tuberculosis was reported. Drug susceptibility test (DST) is the cornerstone to diagnose extensively drug resistant tuberculosis, but the lack of laboratory facilities in the resource-limited endemic countries limits its uses. A few new drugs including bedaquiline and delamanid have the potential to improve the efficiency of extensively drug-resistant tuberculosis treatment, but those drugs are used in 39 countries only. The costs of extensively drug resistant tuberculosis treatment (XDR-TB) are several folds higher than then multi drug-resistant tuberculosis (MDR-TB).

Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: A mathematical modelling study

Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: A mathematical modelling study

Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: a mathematical modelling study

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are emerging worldwide. The Green Light Committee initiative supported programmatic management of drug-resistant tuberculosis in 90 countries. We used estimates from the Preserving Effective TB Treatment Study to predict MDR and XDR tuberculosis trends in four countries with a high burden of MDR tuberculosis: India, the Philippines, Russia, and South Africa. We calibrated a compartmental model to data from drug resistance surveys and WHO tuberculosis reports to forecast estimates of incident MDR and XDR tuberculosis and the percentage of incident MDR and XDR tuberculosis caused by acquired drug resistance, assuming no fitness cost of resistance from 2000 to 2040 in India, the Philippines, Russia, and South Africa. The model forecasted the percentage of MDR tuberculosis among incident cases of tuberculosis to increase, reaching 12·4% (95% prediction interval 9·4-16·2) in India, 8·9% (4·5-11·7) in the Philippines, 32·5% (27·0-35·8) in Russia, and 5·7% (3·0-7·6) in South Africa in 2040. It also predicted the percentage of XDR tuberculosis among incident MDR tuberculosis to increase, reaching 8·9% (95% prediction interval 5·1-12·9) in India, 9·0% (4·0-14·7) in the Philippines, 9·0% (4·8-14·2) in Russia, and 8·5% (2·5-14·7) in South Africa in 2040. Acquired drug resistance would cause less than 30% of incident MDR tuberculosis during 2000-40. Acquired drug resistance caused 80% of incident XDR tuberculosis in 2000, but this estimate would decrease to less than 50% by 2040. MDR and XDR tuberculosis were forecast to increase in all four countries despite improvements in acquired drug resistance shown by the Green Light Committee-supported programmatic management of drug-resistant tuberculosis. Additional control efforts beyond improving acquired drug resistance rates are needed to stop the spread of MDR and XDR tuberculosis in countries with a high burden of MDR tuberculosis. US Agency for International Development and US Centers for Disease Control and Prevention, Division of Tuberculosis Elimination.

Impact of Fluoroquinolone Use on Mortality Among a Cohort of Patients With Suspected Drug-Resistant Tuberculosis.

Previous retrospective and in vitro studies suggest that use of later-generation fluoroquinolones may reduce mortality risk and improve treatment outcomes for drug-resistant tuberculosis (TB) patients, including individuals resistant to a fluoroquinolone. Meta-analysis results are mixed and few studies have examined this relationship prospectively. As part of a comparative diagnostic study, we conducted a prospective cohort study with 834 Mycobacterium tuberculosis-infected patients from selected hospitals and clinics with high prevalence of drug-resistant TB in India, Moldova, and South Africa. We used Cox proportional hazards regression models to assess the association between later-generation fluoroquinolone (moxifloxacin or levofloxacin) use and patient mortality, adjusting for risk factors typically associated with poor treatment outcomes. After adjusting for phenotypic resistance profile, low body mass index (<18.5 kg/m2), human immunodeficiency virus status, and study site, participants treated with a later-generation fluoroquinolone had half the risk of mortality compared with participants either not treated with any fluoroquinolone or treated only with an earlier-generation fluoroquinolone (adjusted hazard ratio, 0.46 [95% confidence interval, .26-.80]) during follow-up. Use of later-generation fluoroquinolones significantly reduced patient mortality risk in our cohort, suggesting that removal of a later-generation fluoroquinolone from a treatment regimen because of demonstrated resistance to an earlier-generation fluoroquinolone might increase mortality risk. Further studies should evaluate the effectiveness of later-generation fluoroquinolones among patients with and without resistance to early-generation fluoroquinolones. NCT02170441.

Extensively drug-resistant tuberculosis in India: Current evidence on diagnosis & management.

Emergence of extensively drug-resistant tuberculosis (XDR-TB) has significantly threatened to jeopardize global efforts to control TB, especially in HIV endemic regions. XDR-TB is mainly an iatrogenically created issue, and understanding the epidemiological and risk factors associated with it is of paramount importance in curbing this menace. Emergence of this deadly phenomenon can be prevented by prompt diagnosis and effective treatment with second-line drugs in rifampicin-resistant TB (RR-TB) as well as multidrug-resistant TB (MDR-TB) patients. Optimal treatment of RR-TB, MDR-TB and XDR-TB cases alone will not suffice to reduce the global burden. The TB control programmes need to prioritize on policies focusing on the effective as well as rational use of first-line drugs in every newly diagnosed drug susceptible TB patients so as to prevent the emergence of drug resistance.

Mobility patterns of persons at risk for drug-resistant tuberculosis in Mumbai, India.

Tuberculosis (TB) hospital in Mumbai, India. To describe the mobility patterns of persons with suspected drug-resistant tuberculosis (DR-TB) and to assess whether there were significant differences in demographic or risk characteristics based on mobility. Observational cohort study of TB clinic patients at risk for DR-TB. Among 602 participants, 37% had ever moved from their place of birth; 14% were local movers (within state), and 23% were distant movers, between states or countries. Univariate multinomial logistic regression models showed that distant movers were more likely than non-movers to have lower income, less education, a greater number of previous TB episodes, and to have ever smoked. Compared to non-movers, local movers were more likely to have lower income and were more likely to have seen a doctor in the past 2 years. Clinical outcomes, including DR-TB, diabetes, and human immunodeficiency virus (HIV), did not differ between the three mobility groups. Mobility was common among patients at risk for DR-TB in Mumbai. TB programs should consider the implications of mobility on the protracted treatment for DR-TB in India.

Totally drug resistant-tuberculosis in India: The bad just got worse

Totally drug resistant-tuberculosis in India: The bad just got worse

Year in review 2012: Lung cancer, respiratory infections, tuberculosis, pleural diseases, bronchoscopic intervention and imaging

This Year in Review series addresses the most relevant articles published in Respirology and other respiratory medicine journals during 2012 concerning five specific areas that we consider to be of importance to practicing pulmonologists, namely lung cancer, respiratory infections, tuberculosis (TB), pleural diseases, and interventional pulmonology and imaging. Some important findings that will be commented on more in depth are that: 1) screening for lung cancer using low-dose computed tomography (CT) in high risk populations is promising, although not firmly established, 2) an enhanced CURB (which stands for confusion, urea, respiratory rate, blood pressure) score as well as the Japanese A-DROP (age, dehydration, respiratory failure, orientation disturbance, and pressure) prognostic scale are as accurate as the pneumonia severity index (PSI) scoring system to predict mortality in patients with community-acquired pneumonia (CAP), 3) randomized trials are urgently needed to optimize multidrug-resistant (MDR)-TB treatment, 4) the use of video-assisted thoracoscopic surgery (VATS) to quantify pleural tumor burden and, if feasible, perform an intrathoracic cytoreduction in patients with malignant effusions secondary to ovarian cancer (OC) may have a significant impact on further patient management plans, and 5) respiratory endoscopy and its different diagnostic and therapeutic modalities, is a safe procedure with overall complication rates less than 1%.

Issues in the management of drug resistant tuberculosis in India

Issues in the management of drug resistant tuberculosis in India

Totally drug‐resistant tuberculosis in India: Who let the djinn out?

Totally drug‐resistant tuberculosis in India: Who let the djinn out?

Totally Drug-Resistant Tuberculosis in India

Totally Drug-Resistant Tuberculosis in India