Initial drug resistance pattern among Pulmonary Tuberculosis patients.

Background: Drug resistant tuberculosis (DRTB) is an emerging problem that adversely affects treatment outcomes and public health in the developing world. Objective: To determine the initial drug resistance pattern among pulmonary tuberculosis patients registered under the Revised National Tuberculosis Control Programme. Study Design: A cross-sectional study design. Setting: Two urban Directly Observed Treatment Supervised (DOTS) centres in Lucknow District of Uttar Pradesh. Methods: The present study consisted of newly diagnosed sputum smear-positive for acid-fast bacilli (AFB) cases at the time of registration under the tuberculosis control programme. All sputum smear positive cases were subjected to culture and drug-susceptibility testing by 1% proportion method on Lowenstein-Jensen (LJ) medium. Results: A total of 185 newly diagnosed sputum smear positive for AFB in pulmonary tuberculosis patients were subjected to culture and drug sensitivity test. Among 185 isolates, 170 (91.4%) isolates were culture positive. Of these 170 isolates, 169 (99.4%) were M. tuberculosis and one (0.5%) was Mycobacterium other than tuberculosis (MOTT). Out of 99.4% M. tuberculosis positive isolates, 21.3% were resistant to at least one drug. Resistance pattern of 21.3% strains of M. tuberculosis showing resistance to single, double, triple, and quadruple drugs were 5.9%, 10.7%, 2.4% and 2.4% respectively. Multi-drug resistance (MDR) was observed in 4.7% isolates. Conclusion: The present study highlights the high rate of drug resistance pattern among the new sputum smear positive pulmonary tuberculosis patients and also high MDR tuberculosis. Routine surveillance of drug resistance profile of patients provides useful information for adopting new strategies of effective treatment within National Tuberculosis Control Programmes in order to combat the threat of MDR-TB in the general population.

Initial Drug Resistance among tuberculosis patients under DOTS Program in Bangalore city.

Background & Objectives: The level of initial drug resistance (IDR) and its trend is a sensitive indicator of the programme efficiency and provides indirect reflection of the quality of tuberculosis services in the area. Studies from some parts of India have reported an increase in the level of IDR to INH and Rifampicin. There is paucity of information on age specific pattern of IDR from India. Frequency of drug resistance in the younger age group provides a precise evaluation of the current situation. The published data from Bangalore (1985-86) pertaining to patients under the National TB programme reported an IDR of 20.6% to any drug. Subsequently, the RNTCP with DOTS strategy to achieve high cure rate was implemented in the area in late 1998. The present study was undertaken in a cohort of 324 new smear positive patients initiated on Cat-I regimen under RNTCP in Bangalore Mahanagara Palike from April to December 1999 to study the pattern of IDR among them, soon after RNTCP implementation in the area. This information would serve as a useful baseline data for the area to assess the impact of DOTS strategy on the levels of IDR subsequently. Material & Methods: Two pre-treatment sputum samples were collected from these patients and subjected to microscopy, culture & susceptibility testing at the National Tuberculosis Institute. The susceptibility testing was done by economic version of proportion method, as per IUATLD guidelines. Information regarding the previous treatment was elicited using a pre-tested semi-structured schedule based on the WHO questionnaire for IDR surveillance and scrutiny of available records. Results: Among the 271 correctly categorized new patients, 27.7% were resistant to one or more drugs. The resistance to streptomycin was highest (22.5%) followed by INH (13.7%), and MDR was 2.2%. The age specific resistance was highest in <25 years and declined significantly in the higher age groups, being lowest (17.7%) in >45 years. Effective RNTCP implementation is expected to show declining trends in the IDR, particularly in the younger age group during the subsequent surveys.

The Clinical Characteristics of Initial Drug Resistance in MDR-TB Patients / 결핵

BACKGROUND: Multidrug-resistant tuberculosis(MDR-TB) in patients is mainly caused by acquired drug resistance, However, a small proportion of MDR-TB is caused by initial drug resistance(IDR), which may be somewhat different from acquired drug resistance. This study analyzed the clinical characteristics of IDR in MDR-TB patients to use the results as basic data in managing the disease. METHODS: A retrospective study of 30 IDR cases in MDR-TB patients from Jan. 1995 to Dec. 1998 was perormed. In order to analyzed the clinical charcteristics, the age, sex, family history, duration of negative conversion, number of resistant drugs, treatment regimens, duration of treatment, extent of disease and cavitary lesion on the chest X-ray was examined. In order too analyzed the level of improvement, the extent of the disease and cavitary lesion on the chest X-ray, tested by Wilcoxon signed rank sum test, and the disease free interval rate of 1-year and 4-year was examined using the Kaplan-Meier method. RESULTS: The mean age of the patients was 46.6 years and the sex ratio 1:1. Six(20%) patients had a family history. The mean negative conversin of the sputum AFB stain was 2.6 months. The number of resistant drugs was 7.6 and the number of used drugs 3.6. Twenty-three(67%) patients were treated for less than 12months and 28(93%) patients were treated with first-line drugs. The extent of the disease and the cavitary lesion on the chest X-ray improved after treatment(p<0.05). Among 13 patients who were followed up for 22.6 months, 2(15%) patients relapsed and the disease free interval rate of 1-year and 4-year was 85%. CONCLUSION: It is recommended that the duration of treatment of IDR in MDR-TB with first-line drugs be 9-12 months even if the extent of disease and cavitary lesion on the chest X-ray improves.