Q: I am a 34 years old male suffering from tuberculosis for the last two years with lymphnodes and bone TB (Rib) with necrosis. I am taking these medicines - Ricnex (450), ethomid (250), gaity (400), coxerin and steptomycin injection (75 gm). Why am I still not getting cured? Please help. To add, my TB is MDR, as confirmed by my treating doctor.

A:The management of MDR-TB (multi-drug resistant tuberculosis) is difficult. MDR-TB occurs in about 3% of new cases, and 12-17% of previously treated individuals. The regimen you are taking is a combination of the following anti-tubercular drugs: rifampicin (450 mg)+isoniazid (300 mg)/rcinex, ethionamide/ethomid (250 mg), gatifloxacin/gaity (400 mg), cycloserine/coxerin (250 mg). Effective treatment with better clinical outcome depends on appropriate selection of second line anti-tuberculous medications (after proper drug sensitivity testing in a quality assured and accredited laboratory), adequate adherence to the treatment regimen (this means taking the right medicines at the right time at the right doses), management of complications of TB as and when required (this may mean performing interventions surgical or otherwise), maintaining good nutritional status. Besides, patients with an active diseases are infectious to others (especially applicable to chest TB and those excreting the bacteria directly to the environment) in the initial periods of therapy, so adequate precautions must be taken. Also consider taking an HIV test from a reliable laboratory after adequate counselling. MDR-TB like TB is treatable and curable provided the right medicines are taken for the right duration. The duration of treatment in MDR- TB involving bone and lymph nodes is prolonged (18-24 months), but may have to be tailored based on clinical response. Most patients with MDR-TB are by definition resistant to rifampicin and/or INH/isoniazid. Hence it is not clear why you are still on these medicines. All cases of MDR- TB should be referred to the DTO (District Tuberculosis Officer) and started/assessed for DOTS Plus regimen (Directly Observed Treatment Short course). The Revised National Tuberculosis Control Program (RNTCP) suggests using a Standardised Treatment Regimen (Cat IV) for the treatment of MDR-TB cases (and those with rifampicin resistance). Cat IV regimen comprises of 6 drugs- kanamycin, ofloxacin ( or levofloxacin), ethionamide, pyrazinamide, ethambutol and cycloserine during 6-9 months of the Intensive Phase and 4 drugs- ofloxacin (levofloxacin), ethionamide, ethambutol and cycloserine during the 18 months of the Continuation Phase. p-aminosalicylic acid (PAS) is included in the regimen as a substitute drug if any bactericidal drug (Kanamycin, Ofloxacin, Pyrazinamide and Ethionamide) or 2 bacteriostatic (Ethambutol and Cycloserine) drugs are not tolerated. I suggest you consult a chest physician experienced in the management of TB including complicated cases such as MDR-TB.