Editorial Notes

MDR-TB and Bedaquiline: Lacunae in Treating MDR-TB in India

State policy of restricting availability of anti-TB drug due to fears of antibiotic resistance is impractical and undemocratic.
By IT's Editorial Board
February 11, 2017


GS (M) Paper-2: “Issues relating to development and management of Social Sector/Services relating to Health”


MDR-TB and Bedaquiline: Lacunae in Treating MDR-TB in India


  • Recently, the Delhi High Court acceded to the plea of a girl that she must be given access to Bedaquiline, an anti-TB drug to treat multi-drug resistant disease (MDR-TB).

What’s the issue?

Bedaquiline’s availability is restricted to just five cities. Since the girl was not residing in the five cities, her domicile status was held against her from being treated with Bedaquiline.

What is bedaquiline? How does bedaquiline work?


  • Bedaquiline is a bactericidal drug which belongs to a new class of antibiotics (diarylquinolines).
  • Although the drug is active against many different bacteria, it has been registered specifically for the treatment of MDR-TB.
  • Bedaquiline works by blocking an enzyme inside the Mycobacterium tuberculosis bacteria called ATP synthase. This enzyme is used by the bacteria to generate energy. Without the ability to generate energy, the TB bacteria die and the patient’s condition can start to improve.

Why the use of Bedaquiline is restricted in India?

  • Since Bedaquiline was the first major anti-TB drug discovered in the last 40 years, the govt restricted its use because of the fear that mycobacterium might develop resistance to the medicine.
  • The rationing of Bedaquiline by the government on the fears of drug resistance is understandable, since, the rampant use of anti-TB medicines had resulted in 4.80 lakh new cases of MDR TB in 2015.
  • In India, around 99,000 new cases of MDR-TB are notified. But, only 164 patients are enrolled for Bedaquiline therapy.

Lacunae in managing MDR-TB:


  • Joint TB Monitoring Mission in its report had pointed out the lacunae within the Revised National Tuberculosis Control Program (RNTCP) in the management of MDR-TB cases.
  • The high-power committee suggested that the rise in drug-resistant TB is because of the inherent weakness of state-run TB control programmes and the lack of awareness among patients, who do not complete the six-month medication.
  • Also, slashing the five-year budget of RNTC from Rs 6,500 crore to Rs 4,500 crore has only added to the problem of TB control in the country.
  • Scientific evidence also suggests that a delay in the treatment of MDR cases only makes the community more susceptible to the spread of infection.

Suggested ways to prevent MDR-TB cases:


Preventing resistance against Bedaquiline is a must, but the manner in which it is being done is impractical and undemocratic. If the priority is prevention of drug resistance, then

  1. Strict surveillance of MDR cases;
  2. Better community outreach programmes to educate the patient & the healthcare provider against treatment dropout;
  3. Quality assurance on available anti-TB drugs;
  4. Educating physicians against the injudicious use of Anti-TB therapy are far better means of preventing MDR-TB cases.

Way ahead:

  • TB is a disease of the poor. A compassionate approach supplemented by scientific rationality is a must in promoting Bedaquiline therapy.
  • The Delhi HC order should be an eye opener to rethink the means of rolling out Bedaquiline therapy more effectively and to introduce other drug treatments (like Delaminate) in India.
[Ref: Indian Express]


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