By Dr. Hemant Pathare
Tuberculosis (TB) continues to remain one of the most significant public health challenges in India. However, over the past few years, there has been a substantial transformation in the way TB is diagnosed, treated, and managed across the country.
1. Evolution of Treatment Regimens
In patients diagnosed with drug-susceptible TB, the conventional treatment regimen consisted of an intensive phase of two months with Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol, followed by a continuation phase of four months with Isoniazid, Rifampicin, and Ethambutol.
With advancements in clinical practice, a newer regimen introduced in 2025 includes two months of Isoniazid, Rifapentine, Pyrazinamide, and Moxifloxacin, followed by two months of Isoniazid, Rifapentine, and Moxifloxacin. This shorter regimen is expected to improve patient compliance and overall treatment outcomes.
2. Drug-Resistant TB (DR-TB): Programmatic Advancements
An injection-free, fully oral treatment regimen for DR-TB has now been implemented across India, significantly improving patient comfort and adherence.
In 2023, out of 25.52 lakh TB patients diagnosed, 24.38 lakh (95.5%) were initiated on treatment. The treatment success rate under the standard six-month regimen stands at 85% in the public sector and 87% in the private sector.
3. Role of National TB Elimination Programme (NTEP)
The National TB Elimination Programme has successfully maintained its focus on TB elimination, even during the COVID-19 pandemic. The integrated health system approach ensured continuity of care and highlighted the resilience of India’s healthcare infrastructure.
4. Emerging Challenge: Drug Resistance
The emergence of drug resistance remains a major concern globally. Resistance to Isoniazid and Rifampicin continues to pose a serious challenge.
Over the past decade:
● MDR/RR-TB among new cases: ~3–4% globally
● Previously treated cases: ~18–21%
In India:
● Reduced from 1.40 lakh (2015) to 1.10 lakh (2023)
● New cases MDR/RR-TB: 2.5%
● Previously treated: 13%
5. Progress in MDR/XDR-TB Treatment Outcomes
India has significantly expanded diagnostic and treatment services for drug-resistant TB.
● MDR-TB success rate improved from 49% (2017) to 75% (2021)
● XDR-TB remains complex due to limited treatment options
● 73% success rate in longer oral M/XDR-TB regimens (2021)
This marks a notable improvement in survival outcomes.
6. Shift to All-Oral Treatment Regimens
All patients with MDR/RR-TB, including those resistant to fluoroquinolones, are now recommended to receive fully oral regimens under programmatic conditions. This transition has significantly reduced treatment burden.
7. New DR-TB Regimen (2022 Update)
The updated guidelines introduced a six-month regimen consisting of:
Bedaquiline + Pretomanid + Linezolid + Moxifloxacin
This is now considered the preferred treatment option for eligible patients.
8. Pre-Treatment Evaluation for MDR/RR-TB
A. Clinical Evaluation
● Detailed history and physical examination (including previous drug use, substance abuse, family planning methods)
● Previous history of anti-tubercular treatment
● Thorough clinical examination
● Nutritional assessment (Height, Weight, BMI)
● Neurological evaluation (if required)
● Ophthalmic evaluation (visual acuity and color vision)
B. Laboratory-Based Evaluation
● Random Blood Sugar (RBS)
● HIV testing (with counselling)
● Complete Blood Count (Hb, TLC, DLC, Platelets)
● Liver Function Tests
● Renal Function Tests
● Serum Electrolytes (Na, K, Mg, Ca)
● Urine Pregnancy Test (for women of reproductive age)
● Chest X-ray
● ECG
Conclusion
India’s fight against TB reflects a strong combination of clinical advancement, policy execution, and healthcare resilience. While significant milestones have been achieved, continued focus on early diagnosis, effective treatment, and management of drug resistance remains essential to achieve the goal of TB elimination.
