Eradication of tuberculosis continues to be a major challenge for the health authorities of developing countries in the world even today despite all kinds of TB control programmes adopted by the governments for the last several decades. The disease burden has a serious impact on the economies of these countries as it kills or debilitates people at their very productive age. Twenty two countries, including South Africa, bear 80% of the burden of TB worldwide. According to WHO, there are around 9 million new cases of TB detected and close to 2 million people die from the disease each year. TB ranks as the eighth leading cause of death in low and middle-income countries. Among adults aged 15–59, it ranks as the third cause of death, after HIV/AIDS and ischaemic heart disease. TB is now the top killer of people living with HIV. In India, TB is rated as a major public health problem and the country accounts for one-fifth of the global TB cases. It is estimated that annually around 330,000 Indians die due to TB. Although TB is curable, the treatment requires taking a combination of drugs for at least six months. And many patients stop taking medicines in between the six months’ course and the disease remains not fully cured. This is probably one of the main reasons for the emergence of drug resistant TB worldwide.
Multidrug-resistant TB (MDR-TB) is the most deadly form of the disease today and it is resistant to two most commonly used drugs in the current four-drug regimen namely isoniazid and rifampicin. WHO treatment standards require that at least four drugs be used to treat TB to avoid the development of further resistance. MDR-TB is not limited to the developing world and several cases are being reported from the developed countries. During the late 1980s and early 1990s, outbreaks of MDR-TB in North America and Europe killed more than 80% of those who contracted the disease. During a major TB outbreak in New York city in the early 1990s, one in 10 cases proved to be drug-resistant. In 2008, an estimated 440,000 cases of multidrug-resistant TB emerged. WHO had already launched Revised National Tuberculosis Control Programme some years ago in the wake of the emergence of MDR TB. In India, the programme for treatment of MDR TB started from 2007 and is currently being implemented in 12 states. RNTCP has prioritized MDR-TB treatment and it is expected to be available in the entire country by the end of 2011.Since its inception, the RNTCP claims to have covered over 12.8 million TB patients saving more than 2.3 million lives in the country. Now, RNTCP has set the new objective of Universal Access to Quality TB care for all TB patients on March 24, the World TB Day. The target is to detect 90% of all TB cases and successfully treat 90% of them by 2015. It is to be seen how realistic would be this objective as the whole treatment regime is based on drugs which are more 50 years old. There has been no serious efforts on the part of the international drug companies or the government research bodies to find a new molecule for the disease all these years. Now that MDR TB has arrived and is spreading fast all over the world, what is urgently required is intensive research efforts to find a new drug for combating the disease.