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The first stage of drug resistant TB is usually called MDR TB: multi-drug resistant TB, because such bacteria is resistant to two (out of the four) anti-TB drugs: Rifampicin and Isoniazid. It  arises because of the failure to take proper medication for DS TB, or leaving the therapy midway. It is necessarily a man-made phenomenon and indicates failure of the health systems and NGOs to provide proper medication and ensure complete treatment. Obviously, MDR TB patients must be moved to different antibiotics, many of which are highly toxic and have terrible side effects. The traditional treatment for MDR TB lasts for two years, involves an injection and over 10 tablets a day for the first six months. Side effects include liver failure, kidney failure and severe depression leading to suicide.

Patients of MDR TB infect others with that dreadful form. Like DS TB, each patient who has MDR TB inside the lungs infects 12 others, leading quickly to an epidemic. This is creating a new health problem. For the benefit of society, low quality TB programs should be shut down by governments and NGOs instead of breeding drug resistance.

The failure to properly treat MDR leads to XDR, extensively drug resistant TB, a more lethal form of the bacteria. Failure to treat XDR leads to Totally Drug Resistant TB (also called XXDR). These are people who are doomed to die a lingering, painful death.

No wonder, the famous Bollywood celebrity Amir Khan called TB a “ticking time bomb”, having taken a leaf out of the book “Time Bomb” by Lee Reichman, founder of the Global Tuberculosis Institute in USA .

DR-TB is a frightening disease. It leads to disruption of families, terrible economic loss to individuals, families, communities, and countries and horrifying human rights violations. The amount of suffering these patients endure is unimaginable. If we do not treat DS TB properly, MDR, XDR and XXDR-TB will develop in the ongoing evolutionary arms race between drug developers and the bacteria.

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