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Clinical Infectious Diseases Advance Access published December 21, 2011
individually and often in incorrect doses,
from multiple private practitioners (mean,
All authors have submitted the ICMJE Form
for Disclosure of Potential Conflicts of Interest.
losis was first described in 2006, Velayati
Conflicts that the editors consider relevant to the
content of the manuscript have been disclosed.
losis in a cohort of 15 patients from Iran,
Zarir F. Udwadia, Rohit A. Amale, Kanchan K.
resistant to all first- and second-line drugs.
P. D. Hinduja National Hospital and Medical Research
Since the first cases of XDR tuberculosis
in India were reported from the P. D.
grappled with increasingly resistant strains
1. Velayati AA, Masjedi MR, Farnia P, et al.
of tuberculosis. We describe the first pa-
Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively
tients from India with TDR tuberculosis.
drug-resistant tuberculosis or totally drug-
patients seek care from private physicians
resistant strains in Iran. Chest 2009; 136:420–5.
in a desperate attempt to find a cure for
2. Udwadia ZF, Jain S, Rodriguez C, Mehta A.
XDR tuberculosis in India: what’s in a name?
their tuberculosis. This sector of private-
3. Anti-tuberculosis drug resistance in the world:
largest in the world and these physicians
fourth global report. The World Health Orga-
nization (WHO)/International Union AgainstTuberculosis and Lung Disease (IUATLD)
was resistant to all first-line (isoniazid, ri-
Global Project on Anti-tuberculosis Drug Re-
sistance Surveillance 2002–2007. WHO/HTM/
streptomycin) and second-line (ofloxacin,
4. Bhargava A, Pinto L, Pai M. Mismanagement
of tuberculosis in India: causes, consequences,
and the way forward. Hypothesis 2011; 9:e7.
berculosis control by private practitioners in
Mumbai, India: has anything changed in two
dicator Tube 960 at critical concentrations
for first-line and second-line drugs rec-
would only have served to further amplify
Correspondence: Zarir F. Udwadia, MD, FRCP, P. D. HindujaNational Hospital and Medical Research Centre, Veer Savarkar
patients underwent genotypic DST analysis
Marg, Mahim, Mumbai 400 016, India (zarirfudwadia@
probe assays (Hain Life Science). A careful
The Author 2011. Published by Oxford University Press on
audit of their prescriptions revealed that
behalf of the Infectious Diseases Society of America. Al rights
reserved. For Permissions, please e-mail: firstname.lastname@example.org.
CORRESPONDENCE d CID 2011:0 (15 October) d 1
Treatment and Resistance Details in 4 Patients Treated With First- and Second-Line Drugs for Tuberculosis
Abbreviations: gyrA, gyrase subunit A; inhA, enoyl subunit A; katG, catalase peroxidise gene; rpob, RNA polymerase b subunit; rrs,16S ribosomal RNA.
a The first- and second-line drugs to which susceptibility was checked included isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, amikacin, kanamycin, capreomycin, moxifloxacin, ofloxacin, para-aminosalisylate, and ethionamide.
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