Tougher bacteria add to patients’ woes, expenses

  • 1,221 patients receiving care for drug-resistant TB
- Manish Gautam, Kathmandu
Tougher bacteria add to patients’ woes, expenses

May 10, 2014-

In September last year, Bishnu Basyal (name changed), 52, of Nuwakot decided to visit Gerkhu Health Post in the area after fever and cough, with blood in the sputum, persisted her for months. Further tests confirmed she had tuberculosis (TB) and she was immediately put on medication. But even after five months of treatment, her illness showed no signs of easing and neither did the lab report show negative for Mycobacterium tuberculosis, the bacteria that causes TB. She was then referred to TB hospital in Kalimati, where a drug resistance test showed Basyal was in fact infected with a drug-resistant strain of the bacteria.

Basyal was diagnosed with a severe form of TB also known as Multi-Drug Resistance (MDR) TB, and moreover her 18-year-old son who assisted her to the hospital was also found to be suffering from the disease. Even though her son had contracted the disease for the first time, it was still of the severe form. Her older son too had the disease, it was confirmed later, with all the three members of the family currently undergoing treatment at the hospital.

Two similar cases were recently reported in Dhangadi in which the patients had developed resistance against artemisinin-based combination therapies (ACTs), a treatment against malaria. One of the patients used to work in Gujarat, India and has been suspected to transmit the disease from the neighbouring country. These cases indicate that anti-microbial resistance has started rearing its ugly head in the country, which, in turn, shows the drugs that were used in the past are now ineffective against certain strains of bacteria, virus and fungi. Such resistance against medicines poses several threats: whenever such strains start proliferating even the first-time patients are usually infected by the higher strains of the diseases, and the treatment can be prohibitively expensive.

According to government data, 2.6 percent of new cases are diagnosed as being infected by drug-resistant TB every year, while 17.9 percent of TB patients, even when treated, are infected with stronger strain of the virus. According to the NTC, 1,221 drug-resistant TB patients are currently receiving treatment, while 271 new cases were reported last year. Furthermore, XDR-TB, the most severe form of TB, has been detected in 71 patients so far.

The cost of treatment also significantly increases in patients with the drug-resistant tuberculosis. It would require Rs 300,000 to Rs 400,000 for patients to get treatment of MDR-TB and around Rs 700,000 is required for XDR-TB patients. If not properly taken care of, these patients pose a serious threat of transmitting the disease to other people, says Dr Bandana Shrestha of the TB Hospital, Kalimati.

The World Health Organisation (WHO) recently published a comprehensive report on the situation of antimicrobial resistance, titled Antimicrobial Resistance: Global Report on surveillance 2014. The report warns that “without urgent action we are heading for a post-antibiotic era in which common infections and minor injuries can once again kill.”

Dr Kumud Kumar Kafle, clinical pharmacologist, says the main concern with antibiotic resistance is that there has been no significant discovery of any new antibiotics in the past three decades as the bacteria continue to get more resistant by the day. WHO states that since the Penicillin in 1920s only three new major types of antibiotics have been discovered, and since the 1990s no such major antibiotics have been developed.

One of the reasons for the growth in resistance by the bacteria is that patients do not follow the prescribed course for taking their medications. The Drug Act 1978 states that antibiotics should be sold only through a doctor’s prescription but the drugs are freely prescribed by many health professionals in the country, regardless of diagnosis.

A study conducted by the Institute of Medicine in 2013 showed an alarming increase in resistance to drugs by the bacteria that bring about typhoid and urinary tract infections. Drugs such as Ciprofloxacin, which was widely used to treat typhoid, have today become ineffective thanks to a rampant prescription of the drug. Experts say that the government should come up with guidelines for the use of antibiotics and they should be followed by all health professionals.

Doctors, likewise, say people should use antibiotics only when they have been prescribed by doctors and that they should complete the full course even if the symptoms of the disease cease in a few days.

Published: 11-05-2014 07:49

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