Who gets to the finish line first?

Carolyn Kavita Tauro, India
It was a casual sit-in with some of my friends back home when one of them who is a mother of a three-year old boy said to me, “Hey tell me! As soon as I get to know that one of my son’s friends is ill, I already give him some antibiotics so that he doesn’t get ill… is this ok”? By the time she had asked me the question, she had realized that maybe it was not ok for her to do it, but like most people she did not know why. Another young mother quickly adds, “But anyway the doctor give so many medicines nowadays”.

There seemed to be some sort of race to get there first. Either the doctor or the parents want a symptomless child as fast as possible. What could be the big concern in irresponsible administration of drugs, even in children?

What Is Drug Resistance?
Drug resistance, in general, is when microorganisms in the body (bacteria, viruses, parasites etc.) do not get affected by a drug that previously cured the infection. Multi-drug resistant Tuberculosis is one such disease that is of major concern today. Isoniazid and Rifampicin are two of the most powerful drugs against TB, and in many people today, the bacteria that causes TB is resistant (or not affected by) to these drugs.

In actual numbers, this amounts to 450,000 MDR-TB cases worldwide out of which 170000 died. The number of MDRTB cases amounts to 64000 cases in India alone, according to the World Health Organisation’s Global Tuberculosis Report 2013. Data is less available for these numbers in children. However, given that about 10-20% of the total cases in the areas where TB control is poor are children, one may say that about 40000 pediatric cases of MDRTB per year may be estimated.

Some of the main causes of MDRTB is the mismanagement of Tuberculosis treatment and the spread of one person to another due to lack of infection control. Incorrect or inappropriate use of antimicrobial drugs, in in sufficient dosages and for shorter periods than required all contribute to this resistance. TB patients often do not complete their six-month therapy that also contributes to this. Once a patient contracts MDRTB he then spreads the strengthened or resistance bacilli to other around him, which means the newly contracted TB is MDRTB.

What can be done? 
Early suspicion, prompt diagnosis and aggressive treatment is the key to saving lives of children with MDRTB. If a child is showing no improvement or a progression in disease both clinically and radiologically, inspite of being on treatment, then MDRTB must be suspected. In addition, doctors should be monitored for inappropriate and inaccurate management of conditions and adherence to guidelines must be implemented. Drugs specific for TB should be reserved and pharmacies should not be allowed to distribute these without prescriptions. Patients and their caretakers need to be advised how administering left-over antibiotics from a previous illness is not the solution but could be the problem in the future.

Carolyn Kavita Tauro, Citizen News Service - CNS
November 2013

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