Combating the emerging threat of drug resistant tuberculosis (TB)
Drug-resistant tuberculosis is posing a great challenge to the control of tuberculosis in Bangladesh. Improper use of the drugs creates step-by-step drug resistant bacteria. It is caused by mutations within natural populations of bacteria. This occurs by the improper use of medications for the treatment of tuberculosis.
Multi-drug treatment was developed to address this problem. The process for the selection and promotion of drug-resistant bacteria has traditionally been a very long process, taking place over decades before it emerges as a major problem among new cases of tuberculosis. The emergence of the TB-HIV epidemic has recently increased the rate by which this occurs.
The problem of drug resistance is first seen among patients who have been previously treated for tuberculosis, particularly those who have had multiple episodes of previous treatments. Among the previously treated cases, those who fail their treatment to complete are the most likely to have drug-resistant bacteria and multi-drug resistance occurs on the major drugs, especially Isoniazid.
Patients with multi-drug resistant TB spreads the same multi-drug resistant TB to a brand new human host. Treatment of these cases poses a real challenge. The treatment is long, toxic and expensive. The costs to patient are frequently so great that the patient, the patient's family and community are increasingly impoverished by the disease and its treatment at hospitals. Diagnosis also poses a challenge for these cases.
Controlling the spread of this dangerous resistant bacterium needs to have a high priority, particularly in health care institutions or other residential care facilities where these patients may spend long periods of time. This requires a high level of awareness of the problem, triage of all those suspected of having tuberculosis for rapid diagnosis and improvement of ventilation where such patients gather.
The Global Tuberculosis Report (2009) estimated MDR-TB rates 3.5 percent and 20 percent among new and previously treated TB cases respectively. Although the rates of MDR-TB in Bangladesh did not appear to be high, but the absolute number may be significant in increasing TB burden.
The extent of anti-TB drug resistance in Bangladesh in not clearly revealed. No national survey has ever been conducted, but the World Health Organisation (WHO) are giving special emphasis to uncover the real picture by nationwide survey.
Resistance to commonly prescribed TB drugs is most often caused by incorrect TB treatment. Factors such as interrupted drug supply, inappropriate prescription or poor compliance permit multiplication of drug-resistant strains of TB. This is especially challenging because the current strategy for tuberculosis control depends on rapidly reducing the risk of infection through finding and treating the infectious cases.
We need to combat the challenge with proper policy and appropriate action.
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