Treatment practices in pulmonary tuberculosis by private sector physicians of Meerut, Uttar Pradesh.

Abstract

To the Editor: Dr Ashish Yadav et al1 showed that majority of qualified private physicians in Meerut were not following the Revised National Tuberculosis Control Programme (RNTCP) regimens to treat pulmonary tuberculosis. Without proper knowledge of principles of intermittent therapy or multidrug resistant tuberculosis treatment, no private medical practitioner can offer correct treatment regimen. The information about treatment regimens under RNTCP is available in the internet.2 If internet facility is not used, books, medical journals, medical conferences or continuous medical education (CME) programmes are other sources of information on RNTCP. An average private medical practitioner in rural or semi-urban area usually does not make use of above sources. This is the main reason for prescription errors and misconceptions about intermittent treatment regimens of TB. Different effective daily treatment regimens were developed in the past to treat tuberculosis (TB) and have been included in standard medical books. When same drugs are given, therapeutically RNTCP regimen can only be as effective as daily short course regimen. The article did not mention the percentage of qualified private physicians who started practicing medicine before implementation of RNTCP in our country. I learnt only daily treatment regimens of TB during my postgraduate course in 1991 as there was no RNTCP. Before directly observed treatment, short-course (DOTS)plus was introduced, we followed World Health Organization (WHO) guidelines for management of multidrug-resistant (MDR) TB and presented our experience in national conference.3 Even today DOTS-plus facility is created in selected cities that too for treatment failure cases treated under category II regimen of RNTCP. Therefore, DOTSplus programme is meant for patients treated in government sector hospitals only. Authors have not documented whether the qualified private physicians were following WHO regimens for MDR-TB or not. In our place, DOTS-plus committee is for government doctors only and none of the private sector doctors with better qualification and experience in the management of MDR-TB is included that committee. When private sector doctors are not adequately represented in government committees/meetings or scientific programmes or TB conferences, majority of medical practitioners of our country particularly those who secured medical degrees Treatment Practices in Pulmonary Tuberculosis by Private Sector Physicians of Meerut, Uttar Pradesh