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India should screen all tuberculosis patients for drug resistant disease at diagnosis

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1235 (Published 23 March 2015) Cite this as: BMJ 2015;350:h1235
  1. Yogesh Jain, public health physician and paediatrician, Jan Swasthya Sahyog (People’s Health Support Group), Village and Post Office Ganiyari, Bilaspur 495112, India
  1. yogeshjain.jssbilaspur{at}gmail.com

India’s national programme needs to embrace comprehensive screening and test for the isoniazid monoresistance that precedes multidrug resistant disease, says Yogesh Jain

Drug resistant tuberculosis attracts attention because of poor outcomes, the risk of transmission to others, and the financial implications of multidrug resistant tuberculosis (MDR TB). In India the programmatic management of drug resistant TB,1 with a focus on MDR TB, started in 2007 and covered the country by 2012.

The national programme prioritises case finding and treatment of MDR TB even though only half of patients with MDR TB are cured with the existing treatment regimen.2 The programme rightly notes that preventing MDR TB in the community is more important than treatment, but this recognition needs more attention than it currently gets.

Inadequate screening for drug resistance

A first step in prevention is early screening for drug resistance in all patients with TB.3 With improved screening from 2011 to 2013 the number of notified cases of MDR TB in India each year increased nearly sixfold to 25 244. …

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