Management of Pulmonary Tuberculosis Including Drug-Resistant Cases in Private Sector of Mumbai, India

Abstract

Objectives: To find out practices related to management of pulmonary TB in new patients, patients not responding to treatment and diagnosis and treatment of drug-resistance in Mumbai’s private sector. Methods: A total of 42 chest physicians (CP), 51 post-graduates in general medicine (MD), 70 allopathic graduates (AP) and 33 ayurvedic/homeopathic physicians (ISM) participated in this cross sectional study. A pre-designed pilot tested questionnaire was used to collect data. Practices of physicians were compared with the International Standards for Tuberculosis Care (ISTC). Results: Most physicians across all groups reported use of sputum microscopy for diagnosis. ISTC recommended regimens were prescribed by 11 (29%) CP, 15 (31%) MD, 6 (9%) AP and 3 (9%) ISM practitioners for treatment of new pulmonary TB patients. 18 (43%) CP, 13 (26%) MD, 19 (27%) AP and 6 (18%) ISM practitioners prescribed retreatment regimen without investigating for drug-resistance among patients not responding to first regimen. Regimens prescribed by 6 (25%) CP and 3 (9%) MD for treatment of multidrug-resistant TB were as per ISTC recommendations. The specialists (CP and MD) were significantly more likely than family physicians (AP and ISM) to adhere to ISTC recommendations related to diagnosis, treatment and monitoring of new TB cases. Conclusions: Management of TB among new patients was deviating from ISTC recommendations more so among AP and ISM than in CP and MD groups. There is a delay in suspecting drug-resistance in private sector. Majority of regimens offered for treating multidrug-resistant TB are not individualised and most are inadequate. There is a need to train physicians in Standards for TB Care in India (STCI).