Dr Anand Jaiswal, Director, Pulmonology, Medanta, Gurugram talks to Gunjan Sharma about how mycobacterium tuberculosis is responding to the new anti-TB drugs and why those suffering from active tuberculosis need good nutrition and psycho-social support along with medicines. Excerpts…

What kind of tuberculosis cases do you see these days? 

Most tuberculosis cases are drug-sensitive and respond to the regular TB treatment, but some show drug resistance and can be categorised into multi-drug resistant and extreme drug- resistant. 

How has the TB treatment changed in the last 5-6 years? 

TB treatment has evolved. Earlier, patients had to consume a number of pills. Now, we have combination drugs, which are like four drugs in one tablet. These combination drugs are as effective as individual drugs. We prescribe them as per the patient’s body weight. 

To treat drug-resistant TB, now we have new drugs—Bedaquiline, Delamanid, and Linezolid. Most patients respond well to these drugs. Injectibles have been replaced by oral drugs, making it easier for patients.

The treatment duration is six months for drug-sensitive TB, which in some cases is extended to nine months. For drug-resistant tuberculosis, in some cases we prescribe a shorter 9-month bedaquiline treatment, in others we prescribe 18-20 months of oral bedaquiline treatment. In some cases of extra-pulmonary tuberculosis such as brain TB, Bone TB, etc, doctors may advise longer duration of treatment. 

It is said that anti-TB drugs have severe side-effects. How do you manage these side-effects? 

Mycobacterium is a difficult pathogen and we need strong antibiotics against it. These medicines do have severe side effects but these are generally temporary and last till the treatment. Specific medicines have specific side effects such as Bedaquiline, a very potent drug against MDR TB can cause arrhythmia, or an increased heart rate; Linezolid can affect haemoglobin and blood platelet count; other drugs can impact the liver, joints, vision and cause redness of the skin. 

We need to keep a check on these side effects by doing blood tests periodically. Patients on Bedaquiline are advised ECG on a regular interval. 

What role does nutrition play in TB treatment? 

A TB patient loses a lot of weight. So we advise the patient to eat well, consume energy-rich food along with adequate fruits and vegetables. 

What do you think of schemes such as Nikshya Mitra? 

It is a good move that can help under-nourished patients receive additional nutrition. Besides, schemes like this open a discussion. When you talk about something so openly, it helps mitigate misconceptions and the stigma attached to it. TB patients need moral support from families as well as the community

The interview was first published in Citizen Matters