[Science] Tuberculosis and DOTs Therapy

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Possible questions

•  4TF related to DOTs and TB for CSAT, 
•  2 markers for mains: MDR:TB, DOTs etc. 
• Essay/Interview: Healthcare reforms in India. How to eradicate Polio, TB and Malaria etc? 

Crux of DOTs program for TB is this:

• If people don't take anti-TB drugs regularly, New version of TB bacteria will evolve,
• New version of TB bacteria= hard to kill.
• Pharma Cos don't have interest in investing for R&D of new TB drugs (because profit margin is low)
• So what should Government or W.H.O. do?
• ans. Make people take drugs regularly. That's why you need DOTs program.

Here goes the 'refined' answer:

MDR TB: Multi-drug resistant TB

• TB patients have to complete the full six to nine months of antibiotic therapy required to cure the disease.
• However Many people stop taking antibiotics when they begin to feel healthier, but successful treatment of TB requires therapy beyond the period of obvious symptoms.
• When patients fail to follow the prescribed treatment, they may become actively infectious, spreading the disease to others.
• The TB bateria who survive this phase become resistant to the given anti-biotic course and when they reproduce again, it is very hard to kill them.
• When a strain (version) of tuberculosis bacteria is resistant to two or more 'first-line' antibiotic drugs it is called multi-drug resistant TB or MDR-TB.
• When it is resistant to three or more 'second-line' antibiotics as well, it is classed as extreme drug resistant tuberculosis, or XDR-TB.
• Big pharmaceutical companies donot like to invest billions of dollars in research and Development of new TB drugs because of the low profit.

So, This problem of non-compliance (i.e. patient not taking drugs regularly) has led WHO to initiate DOTS program.

What is DOTs therapy for TB?

• World Health Organization (WHO) started a program called directly observed treatment, short-course (DOTS).
• DOTS requires health workers to monitor patients to make sure that they follow the complete course of treatment.

Important elements of this program:

1. Political commitment to a National Tuberculosis Control Programme
2. Microscopy services to detect sputum.
3. Regular uninterrupted supply of anti-TB drugs.
4. Direct observation of the treatment for at least initial intensive phase. As a part of DOTS strategy health workers  counsel and observe their patients swallowing each dose of powerful combination of medicines.

TB and HIV

Anyone can become infected with TB, but people with HIV are at greater risk of getting sick with TB disease.

Epicenters

Number of TB patients worldwide:

#1 is India (World's largest Democracy also has the largest number of TB patients)
#2 is China.


Similarly Polio is confined to four nations only: India, Afghanistan, Nigeria, and Pakistan.

BCG vaccine

It is a vaccine for TB protection.
but the vaccine is now very old and not very effective against new strains (versions) of bacteria.