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Review Article

SRP. 2012; 3(1): 37-41


Super TB: Another Manmade Disaster

Aditi Chaturvedi, Rangeel Singh Raina, Vijay Thawani, Harish Chaturvedi, Deepak Parihar.




Abstract

Resistant tuberculosis is aman made disaster due to negligence of patients, physicians, and
policy makers. It has been fuelled by inadequate use of sputum smear microscopy, excessive
dependence on chest radiography, illogical manufacture and irrational prescription of improper
combinations of medicines, inadequate dose,duration and noncompliance to the prescribed
treatment. The resultant gift is the dreaded Totally Drug Resistant Tuberculosis (TDR-TB). Culture
and drug sensitivity testing (DST) should not blindly direct the management of TDR-TB, but has
the importance in individualising the drug therapy in TDR-TB patients.The DST which is a crucial
part of Directly Observed Treatment Short course (DOTS) plus has been introduced in a phased
manner in India. However measuring resistance to second line anti-tubercular drugs (SLDs) with
DST is complex and lacks standardization. The WHO has categorized the SLDs based on their
efficacy. Most of the DST methods have a turnaround time of several months and empirical
regimen should be switched to individual regimen depending on DST results. Newer assays like
microscopic observation drug susceptibility assay,line-probe assay and bacteriophage assay can
be used for rapid detection of drug resistance. Pharmacovigilanceis urgently needed for resistant
tuberculosis as SLDs are less efficacious and more toxic. Presently, the treatment of TDR-TB is not
consolidated. Precaution in the treatment, prevention of spread of the infected cases and use
of newer vaccines are some of the strategies which have to be used to contain the new mighty
variant of microbe mycobacterium tuberculosis.

Key words: Drug sensitivity testing, Totally drug resistant, Tuberculosis, XXDR






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