first and second line anti TB drug resistance pattern in Lahore

For the control of tuberculosis at national level, DOTS strategy [Directly observed therapy short course] is being implemented by National TB Control Program in collaboration with WHO. This programme if managed properly can cure nearly all-new TB patients. To determine the in vitro susceptibility pattern of second line drugs in multi drug resistant tuberculosis and inform tuberculosis control authorities and clinicians for appropriate management. A total of 1180 Mycobacterium tuberculosis positive patients receiving anti tuberculosis drugs and suspected of having drug resistance were referred to this Center for drug susceptibility testing. Sputa of all these patients were subjected to culture against first line of anti TB drugs. Those resistant to both INH and RIF were subjected to 2nd line of drug susceptibility testing. Out of 1180 suspected MDR-TB cases, 201[17%] showed resistance against both INH and RIF thus, confirming MDR-TB. Using the definition of extreme drug resistant TB [XDR-TB] i.e. MDR TB plus resistance to any one of floroquinolone and one of three injectables i.e. amikicin, kanynamicin and capreomycin, 4[2%] cases were XDR-TB. The frequency of XDR-TB was 2%. For MDR TB cases second line of anti tuberculosis drugs are still very effective

Factors responsible for failure to initiate tuberculosis treatment among smear positive tuberculosis patients

Tuberculosis is a major health problem in many parts of the world. Delay in initiation of the treatment may result in prolonged infectious state, drug resistance, relapse and death. To determine the factors responsible for not starting tuberculosis treatment among smear positive tuberculosis patients. Study type, settings and duration: This cross sectional study was done at Pakistan Medical Research Council TB Research Center, King Edward Medical University, Lahore, from 5th March 2010 to 5th December 2010. Patients and Methods: Fifty sputum smear positive patients of tuberculosis who did not register themselves in treatment register and presumably did not initiate anti tuberculosis treatment were contacted using telephone or traced by their home addresses. Once contact was established, they were inquired about the reasons for not starting tuberculosis treatment. Of 50 patients 38[76%] belonged to the lower socio economic class and 12[24%] to the lower middle class. Fourteen patients [28%] were illiterate and 23[46%] had only 8 years of education. Of the 50 cases 41[82%] were taking treatment from traditional healers and 4% did not go back to the DOTS program. Physical condition of the patient, social, domestic and religious issues also played some role in default. Lack of health education and poverty were the main factors responsible for non compliance from treatment. Policy message: Sputum testing sites should have a paramedic who should educate the patients about the benefits of treatment and the dangers of default or partial treatment