Abstract
The latest guidelines under Programmatic Management of Drug Resistant TB (PMDT) by the National TB Elimination Programme (NTEP) of India provide simplified regimens for various types of DR-TB including shorter oral Bedaquiline-containing regimen for Multi-drug resistant/ Rifampicin resistant TB (MDR/RR-TB) cases. However, baseline resistance to Fluoroquinolones (FQ) renders a patient ineligible for this shorter regimen. A retrospective record-based study was undertaken to determine the proportion of FQ resistance among MDR/RR- TB patients in the public sector in the state of Goa. Data of available baseline Second line- Line Probe Assay (SL-LPA) results of MDR/RR TB patients diagnosed in Goa from January 2018 to December 2021 was analyzed. Of a total of 213 MDR/RR- TB cases, SL-LPA results of 144 cases were available. Of these, 55 (38%), were resistant to FQ (with or without resistance to second-line injectable drugs). 26 (47%) of the FQ-resistant cases were among newly diagnosed MDR/RR -TB cases while 29(53%) were among previously treated TB cases. The high incidence of FQ resistance among MDR/RR -TB cases is a cause for concern and has many negative implications for their management and outcomes.
Keywords: MDR/RR -TB, SL-LPA, Fluoroquinolone (FQ), NTEP, PMDT
References
- Global TB Report 2020. https://www.who.int/publications/i/item/9789240013131
- India TB Report 2020. https://tbcindia.gov.in/showfile.php?lid=3538
- Guidelines for Programmatic Management of Drug Resistant Tuberculosis in India March 2021. https://tbcindia.gov.in/showfile.php?lid=3590
- Sharma R, Sharma SK, Singh BK, Mittal A, Kumar P. High degree of fluoroquinolone resistance among pulmonary tuberculosis patients in New Delhi, India. Indian J Med Res. 2019;149(1):62-66. doi:10.4103/ijmr.IJMR_1220_17
- WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment. June 2020.https://www.who.int/publications/i/item/9789240007048
- Directorate of Health Services, Ministry of Health & Family Welfare, Government of India CTD. National Anti-TB Drug Resistance Survey. https://tbcindia.gov.in/showfile.php?lid=3315
- Selvakumar N, Kumar V, Balaji S, Prabuseenivasan S, Radhakrishnan R, Sekar G, et al. High rates of ofloxacin resistance in Mycobacterium tuberculosis among both new and previously treated patients in Tamil Nadu, South India. PLoS One 2015; 10 : e0117421.
- Mamatha HG, Shanthi V. Baseline resistance and cross-resistance among fluoroquinolones in multidrug-resistant Mycobacterium tuberculosis isolates at a national reference laboratory in India. J Glob Antimicrob Resist. 2018 Mar;12:5-10. doi: 10.1016/j.jgar.2017.08.014. Epub 2017 Sep 5. PMID: 28887289.
- Desikan P, Panwalkar N, Chaudhuri S, Khan Z, Punde RP, Pauranik A, Mirza SB, Ranjan R, Anand S, Sachdeva KS. Burden of baseline resistance of Mycobacterium tuberculosis to fluoroquinolones and second-line injectables in central India. Trans R Soc Trop Med Hyg. 2020 Apr 8;114(4):249-254. doi: 10.1093/trstmh/trz121. PMID: 3200379
- Mohapatra PR. Fluoroquinolones in multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2004 Oct 15;170(8):920-1. doi: 10.1164/ajrccm.170.8.951. PMID: 15475406.
- Ginsburg AS, Woolwine SC, Hooper N, Benjamin WH Jr., Bishai WR, Dorman SE, et al. The rapid development of fluoroquinolone resistance in M. tuberculosis. N Engl J Med 2003; 349 : 1977-8.
- Hogan, Catherine & Puri, Lekha& Gore, Genevieve & Pai, Madhukar. (2017). Impact of fluoroquinolone treatment on delay of tuberculosis diagnosis: A systematic review and meta-analysis. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 6. 1-7. 10.1016/j.jctube.2016.12.001.
- Seung KJ, Keshavjee S, Rich ML. Multidrug-Resistant Tuberculosis and Extensively Drug-Resistant Tuberculosis. Cold Spring HarbPerspect Med. 2015;5(9):a017863. Published 2015 Apr 27. doi:10.1101/cshperspect.a017863
Corresponding Author
Cigy C Borges,
Microbiologist- Intermediate Reference Laboratory,
Department of Microbiology, Goa Medical College, Bambolim, Goa
DOI: https://dx.doi.org/10.18535/jmscr/v10i11.12
