Anti-tuberculosis drug resistance in Madagascar in 1994-1995.
METHODS
A new tuberculosis control programme has been implemented in Madagascar since 1991. A survey on Mycobacterium tuberculosis resistance to the major drugs was conducted between August 1994 and December 1995.


OBJECTIVE
To determine primary and acquired resistance in pulmonary tuberculosis patients in four main cities.


METHODS
Were included 401 randomly sampled new smear positive patients (36.2% of declared new patients) and 137 recurrent cases (72.9% of declared cases) from 8 centres. Drug susceptibility testing was performed on Löwenstein Jensen medium according to the proportion method.


RESULTS
The male to female ratio was 1.35:1 in new patients (age range 11-74 years) and 1.98:1 in recurrent patients (age range 16-76 years). The primary resistance rate to any drug was 20% (95% Confidence Interval [CI] 16-23) and the acquired resistance rate 40% (95% CI 32-48, P < 2.10(-7). Primary resistance to one drug was 18% (95% CI 15-22), mainly attributable to streptomycin resistance (14.5%). Multidrug resistance (MDR) to isoniazid and rifampicin was 0.25% (95% CI 0-0.7) for primary resistance and 5% (95% CI 2.6-10.6) for secondary resistance. No difference was observed between sexes or ages.


CONCLUSIONS
This survey conducted in big cities gives a very negative picture of resistance in Madagascar.
Chanteau
S
S
Institut Pasteur de Madagascar, Antananarivo, Madagascar. chanteau@pasteur.pasteur.mg
Rasolofo
V
V
Ramarokoto
H
H
Rasolonavalona
T
T
Ratsirahonana
O
O
Ratsitorahina
M
M
Rakotomanana
F
F
Boisier
P
P
Cauchoix
B
B
Aurégan
G
G
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D016001:Confidence Intervals; D003625:Data Collection; D005260:Female; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011897:Random Allocation; D012008:Recurrence; D017678:Sex Distribution; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology*
D000995:Antitubercular Agents