Rizwan Iqbal, Iffat Shabbir, Saulat Ullah Khan, Shumaila Saleem, Kashif Munir.
Multidrug resistance tuberculosis in Lahore.
Pak J Med Res Jan ;47(1):22-5.

Objectives: To estimate drug resistance in TB patients and compare it with the previous studies to see if there is a changing trend. Settings: PMRC TB research centre Mayo hospital Lahore which is a specialized centre on research and diagnosis of tuberculosis. Patients and Methods: The centre receives sputum samples from all the leading hospitals of Lahore. This work was done from 2004 to 2006 where five first lines anti tuberculosis drugs were tested on LJ.medium using standard proportion method. Results: A total of 582 confirmed isolates of Mycobacterium tuberculosis were seen. Of the total 454 were pulmonary and 128 extra pulmonary specimens from 582 patients. These patients comprised of those with and without history of previous treatment. These sputa were subjected to drug susceptibility testing. Almost half of the patients had some resistance; multiple drug resistance (MDR) was seen in 12.8% and 27.0% cases without and with history of previous treatment respectively. Overall resistance to rifampicin was 26.6%, to isoniazid 23.5%, streptomycin 19.5%, ethambutol 11.8%, and to pyrazinamide 29.7%. Statistically significant difference was seen between primary and acquired resistances. When compared with the reports from previous studies from the same area, there was a trend of gradual increase of drug resistance in this area. Conclusion: Resistance to anti tuberculosis drugs is high in Lahore. The current approach may not be adequate and innovative approaches such as DOTS-Plus may have to be employed to effectively control MDR TB.

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