Diptendu Bhattacharya and Ashna Ashesh, both multi-drug resistant tuberculosis survivors and associated with Survivors Against TB, highlight the enormous burden of drug resistant TB in India and how best to deal with the challenges.
Today, antibiotics are in everything from handwash to animal food products. We pop antibiotics like candy without proper consultation from a doctor even when we suspect a viral infection like the flu and now Covid-19, even though antibiotics kill bacteria, not viruses.
The discovery of antibiotics has helped fight a broad range of bacterial infections. Infections, like tuberculosis (TB), that were earlier definitely fatal, are curable today.
However, the extensive use and misuse of antibiotics have created a huge public health crisis as predicted by Alexander Fleming, the father of antibiotics.
Antibiotic resistance
This crisis is known as drug-resistance (or more specifically antibiotic resistance) wherein certain bacteria have evolved genetically to become resistant to antibiotics. This makes the bacteria resistant to the antibiotics being used to treat the infection and allows infections to grow unchecked. This drug-resistant bacteria then has the potential to spread from the patient to other members in the community if proper hygiene and infection control measures are not observed.
As this year’s World Antimicrobial Awareness Week (WAAW) (18-24 Nov) is taking place during the Covid-19 pandemic, this gives us an opportunity to focus on preventing the worsening of the ongoing antibiotic resistance crisis in the context of infectious diseases.
Drug resistant TB
We must learn from the experiences of persons with drug resistant TB (DR TB) and promote the responsible and prudent use of antibiotics
In TB, drug resistance has become a major public health challenge. DR TB is a form of TB where the first line of medication that ordinarily works in TB (in drug-sensitive TB) does not work to kill the infection.
As survivors of drug-resistant TB here is a snapshot of the world of drug-resistant TB and why it is such a threat. DR TB has a treatment success rate of less than 50 per cent globally in forms of DR TB like MDR TB (multi-drug resistant TB) and thus a higher mortality rate than drug-sensitive TB. The treatment is long and costly - it lasts for at least 2 years as compared to the 6 months for drug-sensitive TB.
On an average, a DR TB patient has to take about –
- 14000 pills in these two years,
- Painful injections every day for six months
- Deal with side effects like nausea, loss of appetite, burning in the hands and feet, possible loss of hearing or sight, mood swings and depression.
- Not to mention the social costs of treatment such as isolation because of TB-related stigma.
The reasons for the emergence of drug-resistant TB vary - patients consuming antibiotics indiscriminately by either skipping doses or leaving treatment midway the second they start feeling better, and doctors prescribing the wrong combination of medication or prematurely discontinuing treatment.
India has the highest burden globally of drug-resistant TB - estimated 130,000 cases that account for about 24 per cent of the global burden.
So how can we deal with the challenge of drug resistance in TB?
- TB patients should use antibiotics only as and when prescribed by a doctor. It is critical to never miss a single dose of medication and adhere to treatment to avoid the development of resistance. They can ask a family member or friend to help them keep track of their doses to not miss doses, or opt for adherence techniques like DOTS, MERM if these are available to them.
- Second, is to always complete the course of antibiotics, to not stop taking antibiotics even if they are feeling better unless the doctor says they can stop.
- Doctors should prescribe antibiotics for TB responsibly and per the standard national and international TB treatment-related guidelines. They should counsel patients that while antibiotics may have their side effects, the difficulties in treatment are challenging but generally temporary. However, if patients complete treatment without skipping their antibiotic dosages or giving up midway, they have a shot at a fuller, happier and healthier life. It is also important to let the patient know what adherence techniques are available. The alternative is possibly contracting drug-resistant TB which can be fatal.
- The government ought to sensitise the public about drug/antibiotic resistance in general and in TB, the dangers of irregular use and misuse of antibiotics, and the importance of completing treatment. It ought to sensitise health providers to prescribe proper, standardised regimens for TB and ensure patients receive adherence counselling remotely now that visiting a DOTS centre may be a challenge in light of Covid lockdowns.
- Chemists should be sensitised to not sell antibiotics for TB without a prescription because TB medication qualifies as an H1 drug (drugs that should not be sold without a prescription from a registered medical practitioner) and to maintain a record of the H1 drugs they sell.
As India and the world battle a pandemic, we cannot afford to risk the development of newer drug-resistant forms of TB or the worsening of the existing drug-resistant TB crisis.
So in keeping with this World Antimicrobial Awareness Week’s theme - handle with care - let’s handle antibiotic usage and our lives with care, in TB and beyond.
(Diptendu Bhattacharya is an educationist and Ashna Ashesh is a lawyer and public health professional. Both are MDR-TB survivors and Fellows associated with Survivors Against TB, a collective of survivors, advocates and experts working on TB and related comorbidities.)
