Evolution of treatment protocols
India has taken significant steps to modernise its TB diagnosis and treatment strategies. Molecular diagnostic labs have now been established across blocks, offering quicker and more accurate testing. Additionally, mobile diagnostic vans are being deployed to rural and tribal belts, helping identify cases that would otherwise remain undiagnosed.
“Treatment protocols have evolved as well. Drug-resistant TB, once a major concern, is now being tackled with newer, shorter, and all-oral regimens like BPaLM (comprising bedaquiline, pretomanid, linezolid and moxifloxacin). These advanced regimens are critical in improving outcomes for drug-resistant cases, which were earlier extremely difficult and costly to manage. The treatment is also for a much shorter duration of 26 to 38 weeks,” said Dr Pothal.
Dr Subhashree Samantaray, associate consultant (infectious diseases) at Manipal Hospitals said drug-resistant TB has become a growing concern. It develops in two forms – multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), both of which do not respond to the standard first-line drugs. Treatment for such cases is more prolonged, toxic, and expensive, requiring specialised care and second-line medications, she said.
“The standard treatment for drug-sensitive TB involves a combination of second-line drugs like bedaquiline, linezolid, moxifloxacin, and ethambutol, in addition to traditional first-line drugs like isoniazid and rifampicin for a duration varying from six to 18 months. Under India’s National TB Elimination Programme (NTEP), diagnosis and treatment are provided free of cost. The programme provides free medications for active TB cases known as directly observed treatment short course (DOTS). Management of latent TB cases has been introduced with TB preventive therapy (TPT),” Dr Samantaray said.
Preventing TB is as important as treating it. The BCG vaccine, administered to infants, provides protection against severe forms of TB, especially TB meningitis and disseminated TB in children. Although its effectiveness in preventing adult pulmonary TB is variable, it remains a key part of India’s universal immunisation programme.
Public health experts stressed that early detection and treatment of latent TB can help stop the infection from becoming active and spreading, and ultimately achieving the elimination target.
Additionally, improving ventilation in living spaces, avoiding close contact with TB patients without precautions, wearing mask in high-risk areas, and maintaining good personal hygiene can significantly reduce transmission.
