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Treatment of Highly Drug Resistant Pulmonary Tuberculosis.

This article includes the basic details, the prevalence, mortality and morbidity related to Multi-Drug Resistance Pulmonary Tuberculosis (MDR-TB). It also includes one of recently published novel and applicable drug regimen for the treatment of the disease. This regimen involves a combination of three drugs which have proved to be beneficial although some adverse effects are also stated which can be controlled. This article also deals with the thinking of the people i.e. the myths regarding tuberculosis considering it the deadliest disease. The aim of this article is to make the medicinal approach visible to people and rule out the myths and misconceptions.

INTRODUCTION: Tuberculosis (TB), one of the most widespread air-borne bacterial infections in the world caused by Mycobacterium Tuberculosis. As per WHO, 10 million people are affected; 5.6 million men, 3.2 million women, and 1.2 million children. Patients with multi-drug resistant tuberculosis (MDR-TB) have limited treatment options and historically have had poor outcomes. Drug-resistant TB is a type of strain not responding to at least the first line of anti-TB drugs. The range of occurrence of MDR-TB is more common, about 63.5% in the age group of 15-44 Years worldwide.


DRUG REGIMEN: In an open-label, single-group study in which follow-up is ongoing at three South African sites published in March 2020, we investigated treatment with three oral drugs Bedaquiline, Pretomanid and Linezolid. A total of 109 patients were enrolled in the study

and included in the evaluation of efficacy and safety end points. At 6 months after the end of treatment in the intention-to-treat analysis, 11 patients (10%) had an unfavorable outcome and 98 patients (90%; 95% confidence interval, 83 to 95) had a favorable outcome. The 11 unfavorable outcomes were 7 deaths (6 during treatment and 1 from an unknown cause during follow-up), 1 withdrawal of consent during treatment, 2 relapses during follow-up, and 1 loss to follow-up.



SITUATION OF THE WORLD:

Pakistan being the 6th largest populous country in the world continues to be ranked 5th among the highest TB-burden countries. To decrease the death rate caused by MDR- TB in people of Pakistan, research on the combination of bedaquiline, pretomanid, and linezolid led to a favorable outcome at 6 months after the end of therapy in a high percentage of patients with highly drug-resistant forms of tuberculosis; some associated toxic effects were observed.


WHY TB HAS NOT BEEN ERADICATED? :

Despite of the treatments being discovered the question arises why is TB still one of top most disease related to mortality and morbidity. The answer to this question has been a mystery since long but now a few etiologies have been established of which the major one includes poor sanitary conditions of the developing countries and drug resistance which is now becoming a leading cause for death in TB patients. The habits of people all over the world for taking antibiotics that too which should be taken only in severe cases for every common and minor diseases has led to this conditions that now our bodies are having negligible effect by these drugs. Another situation which is making TB a difficult disease to treat are the myths related to these few of which I will be stating in my essay which includes that TB is incurable –this has led many people to lose their will power and surrender to death that when nothing is going to happen why to take medicines and waste money. People are also of the opinion that’s once you have been treated for TB you will not contract it again and when they again have the same symptoms they misdiagnose them.


As a nation and as educated people of the country we should on our levels try to address at least these basic misconceptions to play our part in the eradication of TB from this world.

References:

  1. World Health Organization (WHO) report of tuberculosis 2019.

  2. Reports in drug-resistant tuberculosis. Centre for infectious disease research and policy (CIDRAP), March 2017.

  3. Mehari K, AsmelashT, HailekirosH, WubayehuT, GodefayH, ArayaT, Saravanan M. Prevalence and Factors Associated with Multi-Drug Resistant Tuberculosis (MDR-TB) among Presumptive MDR-TB Patients in Tigray Region, Northern Ethiopia, Can. J. Infect. Dis. Med. Microbiol, 2019 Sep;2019:2923549

  4. Conradie F, DiaconAH, NgubaneN, Howell P, Everitt D, Crook AM, Nix- TB Trial Team. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis, N EngI J MED, 2020 Mar; 382(10):893-902

  5. Akhtar AM, Arif MA, Kanwal S, Majeed S. of MDR-TB in retreatment cases of Punjab, Pakistan, JPMA, 2016 Aug; 66(8)

  6. https://asterhospital.com/blog/myths-around-tuberculosis/


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