Bedaquiline : Maybe Miracle Drug for MDR TB, but not to be used casually

New Delhi: The government has recently launched Bedaquiline, an exclusive drug to tackle drug resistant TB cases in the country, among several other initiatives against the disease.

According to the union health ministry, Bedaquiline is being introduced at six identified tertiary care centres across India, having advanced facilities for laboratory testing and intensive care for patients.

"Bedaquiline will be given to multi-drug resistant TB patients with resistance to either all fluoroquinolone (antibiotics for respiratory and urinaryb tract infections)or all second line injectables," said J.P. Nadda speaking about the initiative.

Among several other steps taken by the ministry against Tuberculosis(TB) are the induction of over 500 Cartridge Based Nucleic Acid Amplification Test(CBNAAT) machines.

"This test is fully automated and provides results within two hours. It is a highly sensitive diagnostic tool and can be used in remote and rural areas without sophisticated infrastructure or specialised training. Until 2015, 121 CBNAAT sites have been functional in the country largely providing decentralized testing for detection of Multi Drug Resistant(MDR) TB," said Nadda.

The minister said that with the availability of these additional 500 machines, access to rapid quality assured diagnosis of Drug Resistant(DR) TB and TB will be ensured in all the districts of India either directly or through a linkage by specimen transport mechanism.

"Additionally, the programme will be able to use this highly sensitive state-of-art technology for diagnosis of TB among key populations like children, People Living with Human Immunodeficiency Virus (PLHIV) and extra pulmonary TB patients," said Nadda.

During the occasion the government also released the TB India 2016 Annual Report and the Technical and Operational Guidelines for TB Control in India 2016.

Director for WHO South East Asia region Poonam Khetrapal on the occasion announced that the region has achieved the 2015 Millennium Development Goal of halting and reversing TB incidence. But it is essential to pursue bold new policies to accelerate progress against TB.

"There is another good news that India has also achieved the Stop TB Partnership's target of halving the TB mortality and prevalence rates compared to 1990 levels. Access to TB care has expanded substantially. But it is not enough as bold policies are required as current trends clearly show that without such policies and approaches, the SEA region, including India, will fail to meet the Sustainable Development Goals(SDG) targets to End TB by 2030," said Khetrapal.

According to the WHO, almost 22 million TB patients have been treated in last decade. Treatment success rates among new smear positive pulmonary TB cases have remained above 85 percent since 2005, and were at a high of 88 percent in 2013.

It may be considered as a miracle Drug but its important to follow the following precautions while using this drug:

• Not to be used for routine TB patients


• Not to be used on those MDR cases which have response to routine second line drugs.


• Not to use with Rifampicin since it increases it's degradation in liver reducing it's effect.


• Not to use with drugs like Ketocanazole which increases it's blood levels potentially it's adverse effect.

Point to Note:

The Drug increases the chance of death in a patient taking it by nearly 11.4 percent as against those MDR patients taking routine drugs (approx) 2.5%)

Dosage:

400 mg per day for 2 weeks Followe by 200 mg times a week for 22 weeks.