More than one in two anti-tuberculosis prescriptions assessed in healthcare settings outside India’s National Tuberculosis Elimination Programme (NTEP) did not conform to recommended treatment standards, according to a new systematic review and meta-analysis.
The study also found a significant long-term decline in faulty prescribing. This translates to roughly four to five potentially faulty prescriptions every minute. The estimate is not a direct count of prescriptions issued nationally, but an extrapolation based on the volume of TB treatment provided in the private sector. The study notes that these States also account for a disproportionate share of private-sector TB drug sales, giving them particular importance for TB control. Gyanshankar P. The concern is not only whether a prescription matches a guideline. The study’s discussion notes that faulty prescriptions can compromise treatment efficacy, prolong infectiousness and contribute to drug resistance, potentially undermining TB elimination efforts.
Published in the Indian Journal of Tuberculosis , the PRAMAN India study analysed 34 studies conducted between 1991 and 2024, covering 3,834 real-world anti-TB treatment records. The pooled prevalence of faulty prescriptions was 53.3% (95% CI: 42.2–64.1%). Weighted linear regression showed an average reduction of 1.38 percentage points a year (P=0.013). The crude prevalence fell from 68.6% in studies from 1990–1999 to 32.6% during 2020–2024. The researchers estimated that about 2–3 million anti-TB prescriptions could be incorrect every year in India’s non-programmatic healthcare sector, based on private-sector treatment volumes. Five of the 10 States with the highest TB case notifications, Uttar Pradesh, Maharashtra, Madhya Pradesh, Gujarat and Delhi were among those with rates above this overall prevalence.
Mishra, associate professor of respiratory medicine at Indira Gandhi Government Medical College, Nagpur, and corresponding author of the study, said the reasons for inappropriate prescribing may be more complex than deliberate deviation from treatment guidelines.
