Drug-resistant tuberculosis: Study of clinical practices of chest physicians, Maharashtra, India

Drug-resistant tuberculosis: Study of clinical practices of chest physicians, Maharashtra, India

Patients suffering from drug-resistant tuberculosis (DR TB) avail of private care since Programmatic Management of DR TB (PMDT) is not universally available in India. Management of DR TB is challenging and involves great expertise. Chest physicians (CPs) play a major role in this area. The study was...

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Bibliographic Details
Published in:Lung India Vol. 29; no. 1; pp. 30 - 34
Main Authors: Dholakia, Yatin, Quazi, Zahir, Mistry, Nerges
Format: Journal Article
Language:English
Published: India Medknow Publications and Media Pvt. Ltd 01-01-2012
Medknow Publications & Media Pvt. Ltd
Medknow Publications & Media Pvt Ltd
Wolters Kluwer Medknow Publications
Subjects:
Ayurvedic medicine
Care and treatment
Chest physicians
compliance
Consultants
DR TB
Drug delivery systems
Drug resistance
Drug therapy
Family physicians
guidelines
Homeopathic medicine
Original
Pharmaceutical industry
Physicians
Practice guidelines (Medicine)
practices
Public sector
Questionnaires
Tuberculosis
India
guidelines
Chest physicians
DR TB
compliance
practices
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Summary:Patients suffering from drug-resistant tuberculosis (DR TB) avail of private care since Programmatic Management of DR TB (PMDT) is not universally available in India. Management of DR TB is challenging and involves great expertise. Chest physicians (CPs) play a major role in this area. The study was undertaken with the objective to see whether the practices of CPs comply with current guidelines and to identify areas where they could be involved to improve access to PMDT. For this cross-sectional study, CPs from Mumbai and Nagpur, Maharashtra, India, were given pretested questionnaires to be filled in and returned. Of 70 enlisted CPs, 29 (41%) responded. Twenty-six (89%) respondents used the drug susceptibility test (DST) for diagnosis: private labs and hospitals were preferred; 9 (31%) used standard treatment, 15 (51%) switched to individual treatment after starting standard therapy and 12 (41%) started empirical treatment later switched to individual treatment as per the WHO guidelines. Seven consultants (10%) used in addition drugs from alternative systems of medicine for immune modulation and adverse drug effects. Eighty-six per cent CPs monitored treatment by smear examination, 51% by culture and 93% used X-rays. Reported case holding in the form of regular follow-up consultation visits was around 70%, treatment success estimated to be between 30% and 70%, and deaths around 30%. Adverse drug reactions were reported in around 30% cases. This study shows that most private CPs generally comply with current guidelines for management of DR TB. Accreditation of private labs for DST, involving CPs in diagnosis, treatment and monitoring of patients through public private partnerships can improve access to PMDT.
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ISSN:0970-2113
0974-598X
DOI:10.4103/0970-2113.92359