Difficult to Treat Tuberculosis: A Challenging Vignette in Indian Context

The magnitude of TB disease, including drug resistance, is huge and alarming in India, being the highest-burden country. The steps taken during the initial decades after getting independence in 1947 were slower and not very effective which is reflected in the timeline depicting changes (from NTP to RNTCP and then NTEP) in India’s TB control policies. India has been proactive for the last couple of years with strong scientific, political and financial support in its battle against TB with the ‘WHO End TB Strategy’. To achieve an ambitious goal of eliminating TB by 2025, the program has adopted a multifaceted approach that includes early detection of DSTB and DRTB cases with the genexpert diagnostics, use of potent regimen and preventive care of household contacts. However, a simultaneous multi-dimensional uplift of socioeconomic, educational, nutritional status, personal health and hygiene etc., of the community is not to be ignored. A vignette case of TB with multiple complicating events during management is included to highlight the problem of managing difficult-to-treat TB cases. The role of multidisciplinary specialist expert committee support to deal with adverse drug reactions (ADR) due to newer anti-TB (Bedaquiline, delamanid/pretomanid), use of repurposed antibiotics and efficacious management of comorbidities is also being recognized to strengthen the program. Potent new anti-TB drugs to shorten the duration of treatment, quick diagnostics tools, and effective preventive vaccine with a strong infrastructure laboratory network are the urgent needs of the day