Poor medication regime sees drug-resistant tuberculosis strain flourish
Kuala Lumpur. Lack of adherence to the rigorous and lengthy treatment regime to cure tuberculosis has led to the disease becoming stronger and more resistant to drugs, according to a health official.
It is estimated that about 65,000 people in Indonesia have developed a strain of tuberculosis that is resistant to the drugs that would normally cure the disease, said Tjandra Yoga Aditama, the director general of disease control and environmental health at Indonesia’s Health Ministry.
“The TB treatment takes six to eight months of uninterrupted treatment,” he told the 43rd World Conference of the International Union against Tuberculosis and Lung Disease in Kuala Lumpur over the weekend.
“That requires that patients take the drugs every day. But the adherence is relatively low.”
Indonesia provides TB care for free for people who have been positively diagnosed. This also applies for those who have developed a drug resistance to TB drugs.
However, Tjandra said that for many people, taking drugs every day for months was difficult and time-consuming.
“The drugs are free, but they still need to spend money on transportation to get the drugs from a clinic,” he said.
“Not only that, they often have to leave their work. Meanwhile, most patients feel better after two months so they don’t feel the need to resume treatment.”
Lucica Ditiu, executive secretary of Stop TB Partnership and a leading TB researcher at the World Health Organization, said another problem was that TB treatment could cause some side effects such as skin rashes and nausea.
“The burden of taking pills every day is not what the patient is keen on,” she said.
“They don’t want to take it anymore and that’s when the MDR [multiple drug resistance] happens.”
Ditiu said poorly treated MDR-TB cases could develop into extensive drug-resistant TB (XDR-TB) where the patients had MDR-TB in addition to resistance to at least two more type of drugs. Recovery prospects for those with XDR-TB are only 15 percent. The condition can also develop into totally drug-resistant TB (TDR-TB) where the patient does not respond to any TB drug available.
So far 84 countries have reported XDR-TB cases, including Indonesia, where there are at least five cases.
A recently published WHO report on the Global Burden of Tuberculosis shows that there are 450,000 cases of TB in Indonesia with 65,000 MDR-TB cases.
Manica Balasegaram, executive director of Medecins Sans Frontieres’ Access Campaign, said that if a TB patient developed MDR-TB, they would need to undergo treatment for at least 24 months. Many patients also suffer from severe adverse reactions and the treatment is expensive. The drugs alone cost about $4,000.
Balasegaram added that 60 percent of TB drug resistance cases happened in Southeast Asia and the western Pacific.
Tjandra said Indonesia was developing a program so that MDR-TB patients could be treated at regional hospitals.
“For MDR cases the diagnosis still needs to be done at an accredited laboratory in a well-equipped hospital, but we are conducting training for doctors and nurses at satellite hospitals so they can treat the MDR patients who have been diagnosed,” he said.
Source: The Jakarta Globe
