A 19-year-old tuberculosis (TB) patient who was among the first in India to receive both Bedaquiline and Delamanid drugs died last month after battling the infection for a prolonged period. In her final days, she was on oxygen support after doctors labelled her as “therapeutically incurable”.
Delamanid and Bedaquiline are reported to be the newest effective drugs to come in the last 40 years against TB. While Delamanid has still not been approved for TB patients and awaits trials in India, Bedaquiline was rolled out in 2016 for 600 TB patients nationwide. The Bhayander-based girl managed to procure both the “miracle” drugs by special application to their manufacturers in 2014 and 2015. In May 2015, she completed her Bedaquiline dose. The same year in December, she applied for Delamanid drug, which was approved and started from February 2016 until July 2016.
Despite taking both drugs, according to treating chest physician Dr Zarir Udwadia, the bacteria had spread deep in her lungs.
The 19-year-old passed away last month at her Bhayander residence, painting a sad picture for TB treatment in India and delay by government bodies in rolling out new drugs more quickly. Before she approached Hinduja hospital for treatment, she had approached a few private doctors.
So far, in India there have been only three patients of drug-resistant TB to be administered Delamanid, manufactured by Japanese company Otsuka. The three known cases were treated at Hinduja hospital. The government is now expected to roll it out for selected patients in a few months.
The 19-year-old was a novel case for India, in which doctors first put her on a six-month Bedaquiline regime and later Delamanid. She approached Hinduja hospital after treatment by some private physicians failed. “She was 17 when we wanted to put her on Bedaquiline. Since the norms require a patient to be at least 18 years old, we had to wait until she turned 18,” Udwadia said.
While her weight improved and her x-ray scans showed improvements during the Bedaquiline regime in 2015, the bacterial infection could not be entirely cured. “She did show improvements to Bedaquiline, and wanted to continue it. But the extent of lung damage was severe. There were several cavities,” a doctor managing her case said. Her weight staggered between 35 kg and 40 kg.
In July 2015, overwhelmed by her long-drawn treatment, the girl’s family again approached other physicians and took her to their native village in north India. When her condition worsened, they returned to Hinduja hospital and applied for Delamanid in December. The Delamanid regime ended in August last year but her condition continued to spiral down. Doctors claim she could not even be operated on account of the spread of bacteria in her lungs.
She also represents the increasing chunk of patients who are contracting drug-resistant TB directly and do not respond to half of the drugs available. “Our response needs to get faster to the bacteria,” Udwadia said.