Drug resistance monitoring: combined rates may be the best indicator of programme performance

• Published in: The international journal of tuberculosis and lung disease Vol. 8; no. 1; pp. 23 - 30
• Main Authors: VAN DEUN, A, SALIM, A. H, DARU, P, DAS, A. P. K, AUNG, K. J. M, HOSSAIN, Md. A, RIGOUTS, L, FISSETTE, K, PORTAELS, F
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-01-2004; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Antitubercular Agents - pharmacology; Antitubercular Agents - therapeutic use; Bacterial diseases; Bangladesh; Bangladesh - epidemiology; Biological and medical sciences; Developing Countries; Drug Resistance, Bacterial; Drug Susceptibility; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Microbial Sensitivity Tests; Molecular Epidemiology; Monitoring, Physiologic; Mycobacterium Tuberculosis; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - isolation & purification; Population Surveillance; Prevalence; Primary Prevention - organization & administration; Program Evaluation; Recurrence; Retrospective Studies; Risk Assessment; Surveillance; Treatment Outcome; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - prevention & control; Tuberculosis and atypical mycobacterial infections; Asia; Bangladesh; Performance evaluation; Drug; Treatment resistance; Respiratory disease; Pathogenesis; Rate; drug susceptibility; Mycobacterial infection; Genetic determinism; Indicator; Infection; Bangladesh; Tuberculosis; Mycobacterium tuberculosis; Surveillance; Mycobacteriales; Predisposition; Bacteriosis; Mycobacteriaceae; Bacteria; Actinomycetes; Performance; Monitoring
• ISSN: 1027-3719; 1815-7920

SETTING: Greater Mymensingh District, Bangladesh.OBJECTIVES: To determine changes in prevalence of drug resistance of Mycobacterium tuberculosis under DOTS.DESIGN: Drug susceptibility testing of systematic samples of M. tuberculosis isolated from all sputum smear-positive cases newly registered in sentinel centres during 1995 and 2001. Continuous monitoring of retreatment registrations and resistance of strains from relapse and failure cases.RESULTS: Of 942 strains from the new cases in 2001, 10.8% showed resistance to any drug, 6.2% to isoniazid, 0.4% to rifampicin (all of them multidrug-resistant, MDR), 7.1% to streptomycin, and 1.0% to ethambutol. Corresponding rates for 99 strains from previously treated cases were 32%, 20%, 3%, 20% and 2%, respectively. Although most rates of resistance had decreased since 1995, increased streptomycin resistance was the only significant change when new and previously treated cases were considered separately. However, combined resistance for any drug, isoniazid, rifampicin and MDR had decreased significantly.CONCLUSION: As suggested by monitoring of resistance in failure and relapse cases and by routine programme reports, drug resistance had decreased. Combined resistance demonstrated changes between periodic surveys better than its subgroups, and may be a more reliable and comprehensive indicator. However, continuous monitoring of the pool of resistant retreatment cases is a more efficient strategy.