Can my drug-resistant tuberculosis be treated?

Dr Anuj Sharma
World Health Organization,
Country Office for India,
New Delhi

Q: I am a 24 years old man, suffering from tuberculosis since the past 4 to 5 years. My left lung is completely damaged and the bacteria have entered the right one as well. I have been to PGI hospital in Chandigarh and the doctors there have also given up. Please tell me what I can do to get better.

A:You seem to be suffering from extensively drug-resistant tuberculosis (XDR-TB), which is a relatively rare type of multidrug-resistant tuberculosis (MDR-TB). It is resistant to almost all drugs used to treat TB, including the two best first-line drugs: isoniazid (INH) and rifampicin. XDR-TB is also resistant to the best second-line medications: fluoroquinolones and at least one of three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).Because XDR-TB is resistant to the most powerful first-line and second-line drugs, patients are left with treatment options that are much less effective and often have worse treatment outcomes. XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. Drug-resistant TB (MDR or XDR) is more common in people who:

Do not take their anti-tubercular treatment regularly.

Do not take all of their TB medicines as told by their doctor.

Develop active TB disease again, after having taken TB treatment in the past.

Have spent time with someone known to have drug-resistant TB disease.XDR-TB can be treated and cured in some cases. Some TB control programs have shown that cure is possible for an estimated 30% of affected people. Successful outcomes depend greatly on the extent of the drug resistance, the severity of the disease, and whether the patient's immune system is weakened. If TB bacteria are found in the sputum, the diagnosis of TB can be made in a day or two, but this does not distinguish between drug susceptible (regular) TB and drug-resistant TB. To determine drug susceptibility, the bacteria need to be grown and tested against antibiotics in a laboratory. The drug susceptibility for TB, and especially for XDR TB, may take from 6 to 16 weeks.