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Free Content Prevalence of primary multidrug resistance to anti-tuberculosis drugs in Pakistan

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SETTING: Pakistan ranks sixth in the world in terms of tuberculosis (TB) burden, with a World Health Organization estimated incidence of 181 per 100000, or 286000 new cases annually. Hospital-based data indicate a significant problem of multidrug-resistant TB (MDR-TB) in the country and highlight the need to assess its extent at community level. In this cross-sectional study, sputum samples from 742 untreated newly diagnosed pulmonary TB patients from all over the country were used.

OBJECTIVE: To assess the prevalence of primary drug resistance in Pakistan.

RESULTS: Of 672 culture-positive patients, 76 (11.3%) showed resistance to one or more drugs. Resistance to streptomycin (10 μg/ml) was found in 36 (5.4%) patients, isoniazid (INH) (1 μg/ml) in 51 (7.6%), rifampicin (RMP) (5 μg/ml) in 15 (2.2%), ethambutol (10 μg/ml) in 12 (1.8%) and pyrazinamide in 22 (3.3%) samples. Forty-six (6.8%) of the isolates tested were resistant to a single drug, 10 (1.5%) to two drugs, 12 (1.8%) to three drugs, and 6 (0.9%) to four drugs, while 2 (0.3%) isolates were resistant to all five first-line agents. Primary MDR-TB was 1.8% (n = 12) (INH 1 μg/ml, RMP 5 μg/ml).

CONCLUSION: The results of this study show a prevalence of primary MDR-TB in Pakistan of <2%, which needs to be addressed through an effective DOTS strategy.

Keywords: MDR-TB; Pakistan; primary drug resistance

Document Type: Regular Paper

Affiliations: 1: Department of Pulmonology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan 2: Department of Microbiology, Agha Khan University Hospital, Karachi, Pakistan 3: TB Control Programme, North West Frontier Province (NWFP), Peshawar, Pakistan 4: Institute of Chest Diseases, Kotri, Pakistan 5: Department of Pulmonology, Ayub Teaching Hospital, Abbotabad, Pakistan 6: Ojha Institute of Chest Diseases, Karachi, Pakistan 7: Gulab Devi Hospital, Lahore, Pakistan 8: Lyari General Hospital, Karachi, Pakistan 9: National TB Control Programme, Islamabad, Pakistan 10: Liaqat National Hospital, Karachi, Pakistan 11: Jinnah Postgraduate Medical Centre, Karachi, Pakistan 12: King Edwards Medical University, Lahore, Pakistan 13: Nishtar Medical College, Multan, Pakistan 14: Allama Iqbal Medical, Lahore, Pakistan 15: Wyeth (Pvt) Limited, Karachi, Pakistan

Publication date: 2008-03-01

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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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