Ziaullah, Anila Basit, Arshad Javaid.
Pattern of drug resistance in pulmonary TB patient in NWFP.
Pak J Chest Med Jan ;12(1):11-6.

Background: The emergence of tuberculous bacillus species resistant to various anti tuberculous drugs has become a serious global threat to the human health. Drug resistance is either primary (from a host harboring resistant tubercle bacilli) or acquired (develops during treatment with anti tuberculosis chemotherapeutic agents because of poor patients compliance or inadequate/ inappropriate treatment regimens). This study is done to evaluate the pattern of drug resistance in our population. Materials and Methods: The record of the patients who attended the chest clinic at Peshawar from 1993-2003 due to suspected drug resistant tuberculosis was analyzed. Those who had a sputum culture and sensitivity report indicating resistance to at least two anti-TB drugs (Rifampicin & INH) were included in the study. Data, including demographic data, sputum smear, and sputum culture were recorded in a specified Performa. Results: Drug resistance was suspected in 77 patients. 43 (56%) were males and 34 (44%) were females, with the age range of 15-60 years (mean age 32.5 years). 4 patients excluded after their sputum C/S showed no growth after 6 weeks of inoculation period. 73 patients were left for further analysis. Culture and sensitivity report showed the following results. 26 patients (36 %) were resistant to all six drugs i.e Isoniazid (INH), Rifampicin ( R ), Streptomycin (S), Ethambutal (E), Pyrazinamide (Z) and Thiocetazone (TH).15 (20%) had resistance to five drugs. 16 patients (22%) were resistant to four drugs while 10 patients (14%) had resistance to three drugs. Only 6 patients (8%) were resistant to combination of Rifampicin and INH i.e 2 drugs. The resistance contributed by individual drugs was: Streptomycin: 66.6%, Rifampicin: 100%, INH: 100%, Ethambutal: 66.6%, Pyrazinamide: 79% and Thiocetazone: 57.5%. Conclusion: Most drug-resistant cases of TB were seen among low socioeconomic status people. Ninety-five percent of cases had a history of treatment at least once, hence the resistance was of acquired type. The commonest drug to which bacilli were resistant was Pyrazinamide i.e 73% beside Rifampicin and INH, to which 100% of cases were resistant i.e. MDR TB.

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