Rizwan Iqba, 1iffat Shabbir, Kashif Munir, Khalid Chaudhry, Ejaz Qadeer.
The first and second line anti TB drug resistance pattern in Lahore.
Pak J Med Res Jan ;51(1):01-4.

Background: 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. Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: The frequency of XDR-TB was 2%. For MDR TB cases second line of anti tuberculosis drugs are still very effective. Policy message: TB DOTS program should keep XDR and MDR figures in mind while formulating new policy.

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