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Free Content Development of acquired drug resistance in recurrent tuberculosis patients with various previous treatment outcomes

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SETTING: Chiang Rai province, Northern Thailand.

OBJECTIVE: To study the probability of acquiring drug resistance to isoniazid (H) and rifampicin (R) on recurrence after treatment success, default and failure, among sputum smear-positive pulmonary tuberculosis (TB) patients treated with standardised short-course chemotherapy.

DESIGN: Retrospective analysis of registration records of TB patients from May 1996 to December 2000 in Chiang Rai, where routine drug susceptibility testing (DST) is conducted for surveillance purposes. Patients registered twice or more were examined.

RESULTS: Of 59 cases treated with HRZE/HR who underwent DST at the time of registration, 31 were fully susceptible to H and R at first registration, of whom four acquired drug resistance to H or R. Of 13 cases resistant to H or R at first registration, 11 became multidrug-resistant (MDR). The remaining 15 patients were original MDR cases. Among 28 MDR or H- or R-resistant cases, six reverted from resistant to susceptible.

DISCUSSION: A high proportion of patients with H- or R-resistant TB became MDR after treatment with 2HRZE/HR. Using this regimen, MDR may increase in a population with a high prevalence of H or R resistance. We are unable to explain why some drug-resistant cases became drug-susceptible. Further investigation is necessary.

Keywords: TB; acquired drug resistance; isoniazid; multidrug resistance (MDR); rifampicin

Document Type: Regular Paper

Affiliations: 1: Epidemiology Division, Research Institute of Tuberculosis, Kiyose, Tokyo, Japan 2: Tuberculosis Division, Ministry of Public Health, Bangkok, Thailand 3: Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand 4: TB/HIV Research Project, Research Institute of Tuberculosis (Japan Anti-Tuberculosis Association) and Ministry of Public Health of Thailand, Bangkok, Thailand 5: Chiang Rai Provincial Health Office, Chiang Rai, Thailand 6: Chiang Rai Regional Hospital, Chiang Rai, Thailand

Publication date: 2004-01-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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