A new study conducted by Pallavi Sinha and group from Institute of Medical Sciences, Banaras Hindu University and Boston Medical Centre has concluded that behavioral factors, like alcohol consumption and smoking, and clinical factors, like previous anti tubercular treatment, increases the risk of multi-drug resistant TB (MDR-TB).
Incidences of the dreadful disease, Tuberculosis (TB) are found to be higher in India with the development of resistance by its causative agent, Mycobacterium tuberculosis (Mtb), to our drugs. The pathogen not responding to a drug is resistance. This resistance is caused by mutations in genes of the pathogen or by acquiring it from other pathogens. The common drugs used in treatment of TB are Isoniazid (INH), Rifampicin (RIF), Ethambutol (ETM), Kanamycin, Fluoro quinolines
The study conducted in a tertiary referral hospital in Varanasi from 2012 to 2014, analyzed all the risk factors associated with TB for Drug Resistance and found clinical, behavioral and demographic risk factors with the association of multi-drug resistant TB (MDR-TB) (resistant to INH & RIF drugs) and extremely drug resistant TB (XDR-TB) (resistant to nearly all drugs). Here, Clinical factors are-HIV, Previous anti tubercular treatment, previous exposure to TB, Household contacts; Behavioral factors are-Smoking, Alcohol consumption; and Demographic are-Age, Gender.
The risk factors for prevalence of TB and MDR-TB were compared. According to the study, nearly 71% patients were resistant to at least one drug, with Isoniazid and Rifampcin being the 2 drugs to which the pathogen is most resistant. Demographic, behavioral factors and clinical factors had a role in prevalence in TB, but the demographic and clinical factors had an insignificant influence in prevalence of MDR-TB, compared to the lifestyle or behavioral factors. Alcohol consumption and smoking increase the risk of MDR-TB by more than 50%. While, higher instances of XDR-TB were observed in patients with previous anti tubercular treatments.
The comparative results of several other studies conducted in different regions of the country show similar results. It shows a general lack of awareness of TB and its treatment. Patient compliance and ignorance are major factors. The study also clearly indicates a strong reasoning for the community to affect behavior, by reducing smoking and alcohol consumption. Proper treatment, surveillance of treatment, regular or periodic checking of patients with TB for MDR-TB, is also a must.
The paper throws into limelight one major issue -- surveillance and finding new drugs for combating MDR-TB. But, creating awareness is a cheaper and better solution for reducing the menace of MDR-TB and communities should strive towards.