Centre agrees to provide restricted TB drug to a Bihar girl; expert advices caution

The Health Ministry promises to make bedaquiline available to 70 centres across India

By Kundan Pandey
Published: Friday 20 January 2017

In March 2016, the government introduced Bedaquiline in six tertiary care centres across India. Credit: CDC Global/ Flicker Finally, the central government has agreed to increase the availability of crucial drug, Bedaquiline, which is used as a last resort for treating multidrug-resistant tuberculosis. The government assured the court on Friday, January 20, to expand the coverage area to 70 centres across the country by the middle of 2017. So far, only six tertiary centres in the entire country were allowed to administer this drug to patients.

In a case filed by a girl from Bihar in Delhi High Court, the National Institute of Tuberculosis and Respiratory Disease (NITRD) in Delhi submitted that eligibility criteria for providing the drug will not include domicile or residential proof and patients from any part of the country can be treated in their hospital. Though the girl was being treated in Delhi but was denied the crucial medicine as she was not domicile of Delhi. Her treatment had begun in 2011. Since then, she has moved from her local town to Patna and then to Delhi.

As the patient needs both Bedaquiline and Delamanid, the girl couldn’t be treated in government hospital. Considering this fact, the government is willing to provide bedaquiline to Zarir Udwadia of Hinduja Hospital in Mumbai, who will treat and monitor the patient. 

Bedaquiline, made by Johnson & Johnson, and Delamanid, manufactured by Ostuka of Japan, are considered only when other drugs do not work on patients.

In March 2016, the Ministry of Health and Family Welfare (MoHFW) has incorporated Bedaquiline in the Revised National Tuberculosis Control Programme (RNTCP) and introduced it in six tertiary care centres across India. These centres are based in six public hospitals in Delhi, Mumbai, Chennai, Ahmedabad and Guwahati.

Madhukar Pai, Associate Director, McGill International TB Centre, says that in general, indiscriminate use (overuse or misuse) of any antibiotic can result in rapid emergence of drug resistance. “We need to be cautious about the introduction of bedaquiline and other new TB drugs. In particular, we cannot just push it in the private market in India, because we know that antibiotic abuse is very widespread in the private sector. Anyone from pharmacists to informal providers can start abusing the new drug.”

Recommending careful use of the drug only in selected public and private centres where it will be correctly admiistered by highly qualified physicians, Pai says, “I do think that India really needs to show greater urgency in rolling out the daily drug regimen across the country. I am glad the Supreme Court is pushing the government to move on the daily regimen roll-out (that has been delayed).”

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