E-DRUG: Global Drug Resistance Surveillance

[Ian Smith <iansmith@mos.com.np>]

E-drug: Global Drug Resistance Surveillance
----------------------------------------------------------
[kindly taken from the TBNET discussion]

The following article is taken from The New England Journal of Medicine;
June 4, 1998: Volume 338, Number 23, which can be found at
http://www.nejm.org/
Also see an editorial by Dixie E. Snider and Kenneth G. Castro in the
same issue.

Global Surveillance for Antituberculosis-Drug Resistance, 1994-1997

Ariel Pablos-Mendez, Mario C. Raviglione, Adalbert Laszlo, Nancy Binkin,
Hans L. Rieder, Flavia Bustreo, David L. Cohn, Catherina S.B.
Lambregts-van Weezenbeek, Sang Jae Kim, Pierre Chaulet, Paul Nunn, for
the World Health Organization-International Union against Tuberculosis
and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance
Surveillance 

Abstract

Background. Drug-resistant tuberculosis threatens efforts to control the
disease. This report describes the prevalence of resistance to four
first-line drugs in 35 countries participating in the World Health
Organization-International Union against Tuberculosis and Lung Disease
Global Project on Anti-Tuberculosis Drug Resistance Surveillance between
1994 and 1997. 

Methods. The data are from cross-sectional surveys and surveillance
reports. Participating countries followed guidelines to ensure the use
of representative samples, accurate histories of treatment, standardized
laboratory methods, and common definitions. A network of reference
laboratories provided quality assurance. The median number of patients
studied in each country or region was 555 (range, 59 to 14,344). 

Results. Among patients with no prior treatment, a median of 9.9 percent
of Mycobacterium tuberculosis strains were resistant to at least one
drug (range, 2 to 41 percent); resistance to isoniazid (7.3 percent) or
streptomycin (6.5 percent) was more common than resistance to rifampin
(1.8 percent) or ethambutol (1.0 percent). The  prevalence of primary
multidrug resistance was 1.4 percent (range, 0 to 14.4 percent). Among
patients with histories of treatment for one month or less, the
prevalence of resistance to any of the four drugs was 36.0 percent
(range, 5.3 to 100 percent), and the prevalence of multidrug resistance
was 13 percent (range, 0 to 54 percent). The overall prevalences were
12.6 percent for single-drug resistance (range, 2.3 to 42.4 percent) and
2.2 percent for multidrug resistance (range, 0 to 22.1 percent).
Particularly high prevalences of multidrug resistance were found in the
former Soviet Union, Asia, the Dominican Republic, and Argentina. 

Conclusions. Resistance to antituberculosis drugs was found in all 35
countries and regions surveyed, suggesting that it is a global problem. 
(N Engl J Med 1998;338:1641-9.)


--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-e-drug@usa.healthnet.org'.