[Answered] Highlight the challenges of drug-resistant tuberculosis (DR-TB) in India. Also, Discuss the new regimens recommended by WHO for DR-TB patients.

Introduction: What are TB, MDR-TB & DR-TB?

Body: Challenges of DR-TB & new methods adopted by India and WHO.

Conclusion: Way forward.

Tuberculosis is a disease caused by the bacteria, Mycobacterium tuberculosis. India constitutes a major burden country with 20% of all TB cases in the world. Multidrug resistant TB (MDR TB) is caused by bacteria that do not respond to at least Isoniazid and Rifampicin, the most powerful, first line anti-TB drugs. Drug-resistant TB occurs when drugs are not properly taken, like incomplete treatment, wrong dosage, wrong length of treatment, wrong combination, unavailability of drugs or poor quality drugs.

Challenges of drug-resistant tuberculosis in India:

  • High patient burden: India has 25% of world’s DR-TB cases with a large number of cases being diagnosed and treated each year.
  • Inaccurate diagnosis: Timely and accurate diagnosis is critical for effective management but challenges like underreporting & lack of the latest diagnostic methods have led to a large no of cases which is being highlighted in WHO report.
  • High cost of treatment: Due to the use of expensive second-line medications, the treatment of drug-resistant TB is not only more difficult but also more expensive. Patients may be deterred from obtaining the right care or from sticking to their regimen by this costly burden.
  • Rapid Urbanization: India’s crowded mega-cities provide a perfect breeding ground for the airborne infection to spread as people travel from rural to urban areas &interact in densely populated environments. UP has the highest number of such patients, followed by Maharashtra.

new regimens recommended by WHO for DR-TB patients.

  • WHO suggested use of molecular diagnostics as the initial diagnostic test which are highly accurate, detect resistance to drugs, are cost-effective, and reduce treatment-related delay.
  • Use of oral medications has reduced the duration of DR-TB treatment from 24 months to 6 months which is a big improvement in medical science.
  • WHO suggests of use of oral BPaLM/BPaL regimen for DR-TB patients,(Pretomanid (Pa) bedaquiline (B), linezolid (L), and sometimes moxifloxacin (M) to form BPaL and BPaLM) has reduced pill intake & is found to be effective at curing 89-91 per cent of multidrug-resistant TB (MDR-TB).


As per India TB Report 2023 most patients in India are still on treatment regimens involving injectables  which are to be phased out at the earliest as per WHO recommendation. The government and medical industry should also ensure that drugs like bedaquiline, pretomanid should be available, accessible, and affordable to Indian citizens with every individual having right to access the best quality healthcare.

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