IMA End TB Initiative: 10 points what every doctor should know about TB
Dr KK Aggarwal
1. Tuberculosis is a public health emergency in view of the rising number of cases of MDR (Multi-Drug-Resistant) and XDR (Extensively-Drug-Resistant)TB
, especially in Delhi and Mumbai.
2. The prevalence of MDR TB is more than 2% in primary TB cases.
3. Every sputum should be tested with GeneXpert test. It not only diagnoses the presence of TB, but also detects rifampicin resistance. No treatment should be started without first confirming rifampicin resistance. Rifampicin resistance indicates primary MDR TB.
4. Treatment for MDR TB should be taken for the required 2 years to prevent conversion from MDR TB to XDR TB. Treatment of MDR TB in India is available free of cost.
5. All doctors/health establishments should register themselves with Nikshay, the online tool for monitoring of TB patients developed by the Central TB Division, Ministry of Health & Family Welfare (https://nikshay.gov.in/HFUSER
If you register with Nikshay, you can get free medicines for your TB patients.
6. Every patient of TB has to be notified as required by the MCI Code of Medical Ethics under Regulations 5.2 and 7.14. Not doing so is professional misconduct.
“5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself.”
“7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –
· in a court of law under orders of the Presiding Judge;
· in circumstances where there is a serious and identified risk to a specific person and / or community; and
· notifiable diseases.
In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately.”
7. In sputum-positive cases, re-test sputum with GeneXpert test after 2 months of treatment to assess response and screen for drug-resistant TB.
8. “Lekin TB Kis se hua?” Trace contacts of your patients with infectious TB and screen them for latent TB infection. Put them on full course of anti-tuberculosis treatment (ATT), if required. This will prevent further spread of TB, including MDR TB.
9. Fixed-dose combination (FDC) drugs are now available for drug-sensitive TB. Treatment has to be as per body weight of the patient.
10. Preferably get a 6-month course of ATT at one time, so that the patient knows he/she has to take treatment for at least this duration of time.