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Table of Contents   
LETTER TO THE EDITOR  
Year : 2014  |  Volume : 7  |  Issue : 1  |  Page : 79
Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

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Date of Web Publication20-Nov-2014
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients. Ann Trop Med Public Health 2014;7:79

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients. Ann Trop Med Public Health [serial online] 2014 [cited 2019 Nov 14];7:79. Available from: http://www.atmph.org/text.asp?2014/7/1/79/145046
Dear Sir,

Under Indian circumstances, a patient is diagnosed to be suffering from multidrug-resistant tuberculosis (MDR-TB), provided sputum culture is positive for Mycobacterium tuberculosis bacilli and is resistant to isoniazid and rifampicin with or without other anti-TB drugs, presuming that the drug sensitivity test (DST) has been done in a laboratory certified by Revised National TB Control Program (RNTCP). [1] Although, the global TB report - 2013 suggest that the incidence of MDR-TB is on the rise, the exact case load is not known owing to the absence of drug resistance surveillance universally. [2] To brought about a significant reduction in the number of drug resistant TB cases in the Indian circumstances, the program managers have advocated for implementation of a good quality Directly Observed Treatment program. [3]

Research findings have revealed that multiple potential determinants (viz. duration of therapy, individual susceptibility, adverse drug reactions, family support, etc.) eventually determine the final treatment outcome. [4],[5] On account of longer treatment duration, infrastructure constraints, and need of periodic follow-up throughout the course of treatment, the program advocates for decentralization of treatment. [1] However, decentralization has its own associated challenges as it requires continuous monitoring & supervision to meet with the needs of the patients. Thus, an expert resource center called as Drug-resistant TB (DR-TB) center has been established in Indian settings to cater a wide range of services to ten million population. [1] These centers have been instituted within the premises of a government medical college hospital. [1],[2]

The functioning of the DR-TB center is executed through a DR-TB center committee, which generally comprises of a Chairperson - Medical Superintendent / Director of the institute; Vice-chairperson - Head of respiratory medicine / general medicine department; Nodal officer; Medical officer of the DR-TB center; Clinicians - Heads of Psychiatry / Gynecology / ENT / Microbiology; one pulmonologist from NGO / private sector; and local program managers. [1]

The DR-TB center has a defining role in the management of drug resistant forms of TB, namely in conducting pre-treatment evaluation (viz. a thorough clinical / laboratory evaluation by a team of doctors to ensure suitability of different patients with the line of management); initiation of treatment; maintenance of hospital wards; implementation of airborne infection control measures; management of severe adverse drug reactions; free laboratory investigations; alterations in the line of management during the course of treatment; shifting patient from intensive phase to continuation phase; transfer-in and transfer-out of patients; management of records; and outcome declaration. [1],[3]

In conclusion, the DR-TB center plays a crucial role in not only ensuring the best possible outcome for drug resistant patients started on treatment, but even acts as a resource center for providing timely guidance to the program managers.

 
   References Top

1.
Guidelines for PMDT in India, 2012. Available from: http://www.tbcindia.nic.in/documents.html. [Last accessed on 2013 Sep 22].  Back to cited text no. 1
    
2.
World Health Organization. Global Tuberculosis Control Report 2012. Geneva: WHO press; 2012.  Back to cited text no. 2
    
3.
Managing the RNTCP in your area - A training course (Modules 1-4). Available from: http://www.tbcindia.nic.in/documents.html. [Last accessed on 2013 Sep 22].  Back to cited text no. 3
    
4.
Hirpa S, Medhin G, Girma B, Melese M, Mekonen A, Suarez P, et al. Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: A case control study. BMC Public Health 2013;13:782.  Back to cited text no. 4
    
5.
Sagar T, Singh NP, Kashyap B, Kaur IR. Current status of multidrug resistant tuberculosis in a tertiary care hospital of East Delhi. J Postgrad Med 2013;59:173-6.  Back to cited text no. 5
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Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, 3rd floor, Thiruporur-Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.145046

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