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

• 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
• DOI: 10.4103/0970-2113.92359
• EISSN: 0974-598X
• ISSN: 0970-2113

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.