Should treatment of multidrug resistant tuberculosis be individualised ?

T e a r t i c l e t i t l e d “ S u c c e s s f u l management of highly drug resistant Tuberculosis with individualized drug susceptibility testing” in this issue of the Journal deserves special attention. It brings forth an important issue of fallacies and benefits of TB treatment offered by private practitioners versus treatment offered by publ ic sector physicians under the revised national TB control programme (RNTCP). Treatment of tuberculosis by private practitioners is often criticised and held responsible for the failure to control the TB pandemic. This is true to an extent as deviation from standardised treatment regimens is an important reason for TB treatment failure. The private practitioners in our country vary widely with regard to expertise and t ra in ing on TB. This leads to patients of tuberculosis receiving all sorts of treatments including different combination of drugs, different doses, different timings of drug administration, variable duration of treatment and the co-prescriptions of other drugs that may be potentially damaging to the outcome of ATT (anti-TB treatment). A study by Uplekar et al in 1991 pointed out that as many as 80 different treatment regimens were used by private practitioners to treat TB, most of which were never validated in any clinical trial.1 A recent study by Udwadia et al in 2010 showed that nothing much has changed even after two decades, with as many as 63 different regimens being prescribed by 106 responding physicians. Only six physicians wrote the correct regimen and three wrote the correct prescription for MDR-TB.2 Case finding is also a challenge in private practice as no Should Treatment of Multidrug Resistant Tuberculosis be Individualised ?