"Tuberculosis specialists in India have diagnosed infections in a dozen patients in Mumbai that are unfazed by the three first-choice TB drugs and all nine second-line drugs.
The doctors are calling them “totally drug-resistant TB,” and the infections are essentially incurable with all available medicines.
It’s a sobering development. Infectious disease specialists say there will surely be more such cases in India and other countries where cases of TB that resist some but not all drugs are being inadequately treated.
Poor care is fueling the development of the superbugs. “The vast majority of these unfortunate patients seek care from private physicians in a desperate attempt to find a cure for their tuberculosis,” the Indian specialists write in Clinical Infectious Diseases. “The majority of these prescriptions were inappropriate and would only have served to further amplify resistance.”
The team did a study that showed only five of 106 private practitioners “wrote the correct prescription for treating TB,” Dr. Zarir F Udwadia, one of the study authors, toldDaily News and Analysis, an Indian publication.
"The other TB challenge is diagnosis, especially of resistant strains, and here again the news is not good," writes infectious disease blogger Maryn McKenna. “The World Health Organization said last spring that only two-thirds of countries with resistant TB epidemics have the lab capacity to detect the resistant strains.”
Johns Hopkins TB researcher Dr. Richard Chaisson tells Shots that ”total resistance is a new phenomenon that is entirely predictable.”
It’s predictable, he says, because hundreds of thousands of people in India have what’s called multidrug-resistant TB, or MDR-TB. And a growing number have “extensively resistant TB,” or XDR-TB. And very, very few of them are getting the expensive, hard-to-take drugs that might cure their infections.
"If you don’t provide supervised second-line drugs, this is what you’re going to see," agrees Dr. Carol Dukes Hamilton of Duke University. "People go to practitioners who aren’t TB experts. They don’t give the right doses or make sure people take them."
Still, the development of these cases of totally resistant TB doesn’t necessarily mean epidemics will sweep through India, or anywhere else, right away. For one thing, there’s no evidence so far that patients with these defiant TB strains are transmitting them to others.”
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