No abstract

Recently the report of the first National Anti-Tuberculosis Drug Resistance Survey (NDRS) from India was released on the occasion of World TB Day this year, i.e., 24th March 2018. The salient features were as follows: 1. MDR-TB is 6.19% (CI 5.54-6.90%) among all TB patients with 2.84% (CI 2.27-3.50%) among new and 11.60% (CI 10.21-13.15%) among previously treated TB patients. 2. Among MDR-TB patients, additional resistance to any fluoroquinolones was 21.82% (17.33-26.87%), and 3.58% (1.8-6.32%) to any second-line injectable drugs. 3. Among MDR-TB patients, additional resistance to at least one drug from each of the two classes, i.e., fluoroquinolone and second-line injectable drugs (XDR-TB) was 1.3% (0.36-3.30%). 4. Any first-or second line drug resistance among all TB patients is 28.0% (CI 26.77-29.29%) with 22.54% (CI 21.10-24.10%) among new and 36.82% (CI 34.64-39.04%) among previously treated TB patients. 5. Any isoniazid resistance is 11.06% (CI 9.97-12.22%) and 25.09% (CI 23.1--27.11%) among new and previously treated TB patients, respectively. 6. Any pyrazinamide resistance is 6.95% (CI 6.07-7.91%) and 8.77% (7.53-10.13%) among new and previously treated TB patients, respectively. The current article reviews the findings of the survey along with their practical implications in the present-day clinical scenario.

resistance to at least all medicines from group A (ie, levofloxacin, moxifloxacin, bedaquiline, and linezolid) is urgently needed. At the start of treatment, the availability of whole-genome sequencing for all patients with confirmed tuberculosis would be ideal. The Rv0678 mutation seems to be an appealing target for developing rapid diagnostic tools for bedaquiline resistance.National tuberculosis programmes across the globe need to develop and scale-up facilities for rapid diagnostic techniques for detecting drug resistance to important second-line anti-tuberculosis drugs, including bedaquiline, in a similar manner in which they are accepting the WHO-recommended bedaquilinebased treatment regimens for multidrug-resistant tuberculosis.We declare no competing interests.

A significantly strengthened Revised National Tuberculosis Control Programme (RNTCP) is currently operational in India. In this case-based commentary, we describe the plight of a patient who developed extensive drug-resistant tuberculosis (XDR-TB) despite having received treatment under the RNTCP for a long period. Our aim is to analyse the programmatic management of tuberculosis in India by highlighting and discussing various issues related to the treatment received by the patient. Further, the article explores whether there is a need to incorporate an ethical element into the RNTCP as it stands today.

No abstract