The Public Health Ministry has rejected calls from victims and experts for the screening of all TB patients to detect and isolate those with drug-resistant strains, saying it would require too much time and money.

Dr Thawat Suntrajarn, director-general of the Department of Disease Con-trol, said testing TB patients to identify different strains was "impossible" because the ministry could not afford to invest the time and money necessary.

"Don't forget that we have to provide [hospital treatment] for the masses. Each day there are thousands of patients, many of them with TB," he

said.

He added that doctors would automatically know whether their patients had a drug-resistant strain of TB when the drugs they prescribed did not show any effect.

"They can then change the drugs, it won't be too late," he said.

However, the ministry's guideline that doctors simply begin TB treatments with first-line drugs is not the most effective way of dealing with the disease, according to Dr Manoon Leechawengwong, chairman of the Siriraj Foundation's Drug-Resistant Tuberculosis Research Fund.

 "It's sort of wasting time and money to make them take medicines that they might be resistant to," he said.

Manoon has pushed hard for all TB patients to be tested for whether the strain they have is drug-resistant and, if so, to which drugs, so that doctors can prescribe effective treatment.

This approach helped cure Punyanutch Heng's teenage daughter Darinthorn of multiple drug-resistant TB (MDR-TB), a strain that earlier claimed the lives of her husband and mother.

The 43-year-old said she only realised after their deaths that there were different types of TB and that more effective treatment could be prescribed if the particular strain was identified.

"When the doctor found that my daughter had TB, he only gave her plenty of medicines and said she would be fine within six months. It was exactly the same thing doctors did when my husband was first diagnosed with TB," she said.

She found later that the medicines prescribed were first-line drugs against the disease.

Learning from her previous experience, Punyanutch took her daughter to Manoon to test which TB strain she had contracted.

Manoon found that Darinthorn had the same TB strain as her father, one that is resistant to five first-line drugs, and prescribed second-line drugs that are more effective

After strictly following her medication schedule and doctors' instructions, the 16-year-old is now healthy and back at school after staying at home for a year.

"Can you imagine what would have happened to my daughter if she had continued taking the first-line drugs that the strain is resistant to?" Punyanutch asked.

She said kept Darinthorn away from public as she was afraid her daughter would spread TB germs to other people.

"We don't want others to suffer like us. And we want all TB patients with multi drug-resistant forms to do the same," she said.

Manoon recently produced laboratory test results that show that 13 Thai TB patients have been infected by extensively drug-resistant TB (XDR-TB) since his fund, which is under the patronage of HRH Princess Galyani Vadhana, began its work in 2001.

He said the cases conformed to the World Health Organisation definition of XDR-TB, which means they are treatable by even fewer drugs than MDR-TB.

Manoon said he had offered to conduct testing of TB samples from hospitals all over the country for free, but the ministry had not taken it up.

According to Thawat, only 2.43 per cent of the approximately 58,000 new TB cases detected each year are of drug-resistant strains, including 0.93 per cent of the MRD form.

He said the detection and isolation of MRD-TB patients was not necessary because the disease is not that easy to spread.

He urged all TB patients to prevent the spread of the disease by wearing face masks, and recommended that people wash their hands frequently to avoid contracting it.

Pennapa Hongthong

The Nation