Q: My girlfriend has been hospitalised with multi drug-resistant tuberculosis. The X-ray showed spots on the left lung, but she doesn't cough and she feels well. She is 21 years old with a generally good health. Unfortunately, she is resistant to most of the drugs. The doctors have put her on Zyvoxid, amoxicillin, tarivid and capreomycin. I checked and found out that some of these drugs are not regular TB drugs. This worries me. Do you think this treatment stands a good chance killing the TB, given her good health and early diagnosis? I would be very grateful for an answer.

A:It is not clear as to how in the absence of symptoms (fever, cough, loss of appetite, loss of weight, tuberculin test etc), a diagnosis of MDR Tuberculosis has been made based merely on spots on the left lung. There can be many reasons for these spots not excluding the possibility of resolved tuberculosis. In any case, if adequate microbiology tests (AFB culture and susceptibiity) have not been done, it would be potentially dangerous to treat the patient. The first line treatment of TB involves three or more of the following drugs: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin. The second line drugs are: kanamycin, amikacin, capreomycin, ethionamide, cycloserine, PAS, thiacetazone, a quinolone (generally levofloxacin or sparfloxacin), clofazimine and amoxycillin+clavulanic acid combination. It would be rare for a patient to be resistant to all the drugs mentioned above. It is necessary to do an antibacterial sensitivity test after isolating tuberculosis germs. Tarivid is the brand name of a drug called ofloxacin. General statement on selection of brands: There are scores, sometimes hundreds, of brands of the same medicine. Against about 300 pharmaceutical manufacturers in western countries like Britain, there are over 20,000 producers in India that market more than 40,000 brands. Most manufacturers do not have quality testing laboratories. Hence selection of brands is important. Many companies give incentives to prescribers to patronise their products. Patients should check the reputation of manufacturers before consuming medicines.