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Survey points to TB pill violation
- 60% prescriptions do not follow dosage rules, says study

New Delhi, May 5: Nearly 60 per cent of tuberculosis medication dose strengths sold in India through prescriptions of private practitioners do not conform with standard TB treatment guidelines, a study has revealed.

The findings corroborate suggestions made by some Indian doctors — several times over the past two decades — that a majority of private practitioners do not write correct prescriptions for treating TB.

The government’s TB control programme provides free TB treatment to more than 70 per cent of patients.

In the new study, US-based researchers analysed the sales of TB drugs in India and nine other countries, examining sales only driven by the private sector.

“Sixty per cent of the pills sold (in the private market) can’t be aligned with the standard guidelines,” said William Wells, a public health specialist with TB Alliance, an international consortium engaged in the development of TB drugs.

The researchers found that annual sales of TB drugs in India through the private sector alone would be enough to treat nearly 2 million patients in a year — which is almost exactly the total number of new cases reported by the Indian government in 2010.

Public health experts say this is surprising because a substantial proportion of patients in the country are treated through the government programme.

“We see larger-than-expected sales of drugs in the private market — why is still unclear,” Wells told The Telegraph in a telephone interview. “It is possible some patients are being over-treated but it is also possible there is more TB in the community than suspected.”

Wells said the results of the drug sales analysis, published this week in the journal Public Library of Science One, appear to complement earlier research findings by Indian doctors who had analysed prescriptions of private practitioners.

Doctors who had analysed prescriptions for TB written by 106 doctors in Mumbai last year found 63 different prescriptions — and more than half were inappropriate. A 1991 study in Mumbai had found 100 doctors writing 80 different prescriptions.

“There has been little change in 20 years,” said Zarir Udwadia, a respiratory medicine specialist at the Hinduja Hospital, Mumbai, and a member of the team that audited the prescriptions from the 106 Mumbai doctors.

Inappropriate prescriptions appear to be fuelling a multi-drug resistant TB epidemic, Udwadia and his colleagues had cautioned in their paper published in Public Library of Science One last year. “Sections of private practitioners need education on standard treatment,” Udwadia said.

The standard TB treatment guidelines recommend four drugs for two months, followed by two drugs for four more months. Inappropriate prescriptions, involving wrong combinations or doses or treatment duration can cause TB bacteria to develop resistance to drugs.

“Many doctors appear to draw their own treatment guidelines based on individual experiences,” said Nerges Mistry, joint director at the Foundation for Research in Community Health, Mumbai.

“I’ve heard some even rubbish the standard guidelines.”

The study by TB Alliance and IMS Health, a market research firm, examined sales of TB drugs in Bangladesh, China, India, Indonesia, Pakistan, Philippines, Russia, South Africa, Thailand and Vietnam, accounting for 60 per cent of the world’s TB burden.

The magnitude of problem dosages in India — 60 per cent — appears higher than elsewhere. On average, about 30 per cent of the private sector dosages of TB drugs in these countries were outside of national or international standard treatment guidelines.

“The size of the problem is an indicator of the size of the response needed,” Wells said.

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