MDR-TB drug shortage continues

Though immediate measures were taken by the authorities last year to ensure the supply of second line treatment drugs of multi-drug-resistant tuberculosis (MDR-TB), no such improvement is being observed by the patients who fall short of medicines every month.

The disruption in supply is adversely affecting the patients, as adherence in terms of the right dosage at the right time is critical in the treatment of TB, failing which the disease may become drug resistant.

In last 13 years over 1,14,000 people have been detected with tuberculosis and its various forms. On an average over 8,000 people contract the disease in the city every year. Shortage in drugs, according to experts, will lead to further deterioration in the condition.

“They were not giving my husband medicines. Twice every week, the TB box they provided came without two or three drugs. They killed him by their sheer carelessness,” cried the wife of 30-year-old Hasmukh Solanki Sanna, who died of MDR-TB at the Sewri TB Hospital on Sunday evening.

However, apart from him, but many others, including children being administered the second line of treatment at various civic hospitals in the city, are facing a serious threat to their lives because of disruption in the supply of MDR-TB drugs.

According to experts, the main reason for the disruption is that the Central government is responsible for buying drugs and distributing them to states, which makes the process unduly long. Civic doctors say that they have been facing the interruption in supply of the drugs for the past three years. The drugs in short supply include capreomycine, ethionamide, paminosalicylic acid (PAS), cycloserine and INH.

In the city, medicine boxes are dispensed to the local DOTS care centre from Pune. “We get boxes which we then supply to many patients or they come here to take it from us. Many a times, the boxes are supplied without two or three medicines. The medicine that is always in short supply is PAS. We either try to get it from older, unused boxes or from other DOTS centres,” said an official from a local DOTS centre.

A doctor from the Sewri TB Hospital, on condition of anonymity, said, “New diagnostic machines have improved detection of the disease and the number of patients is expected to rise three-fold in future. If we fail to provide drugs to the patients, the results will be horrifying because the disease is highly communicable and life-threatening.”

“Interruption in drug supply can lead to death or development of extensively drug-resistant tuberculosis (XDR-TB), which is life-taking with very bleak chances of survival,” said a senior chest physician from a civic hospital, requesting anonymity. “XDR treatment is not as effective as the first line and takes at least three times longer to work if at all it works. Also, the drugs are toxic and are very expensive.”

Another doctor from Sewri TB Hospital summed up the problem saying, “As a doctor, I know the disease, I know how to manage it, but I feel powerless because we don’t have the medicines to treat it.”

Doctor speak

Dr Deepesh Reddy, an ex-adviser to RNTCP and WHO on the TB programme, said, “India is facing a high burden of tuberculosis the highest in the world according to recent WHO reports. Trying to manage the health of people of a vast country like India from the Centre is not only foolish, but also fraught with danger and waste of resources. Ordering of drugs and their distribution must take place at the local level, as the local authorities are more aware of the situation on the ground and are more accessible to people.”

Dr Suhasini Nagda, director of BMC Hospitals said, “We have been conducting many meetings with the head of pulmonary departments of various hospitals. We have requested the directorate general of health services for giving the authority of ordering the drug, its collection and dispensation to state and local authorities. We will soon find a way out.”