[Mycobacterium tuberculosis resistance to antitubercular agents in Antananarivo in 2000].
In 1991, the National Tuberculosis control Program (NTP) of Madagascar adopted the short treatment course and the Directly Observed Treatment Strategy (DOTS), according to the recommendations of the OMS/UICTMR. Development of M. tuberculosis primary resistance to the four antituberculosis drugs (streptomycin [S], rifampicine [R], isoniazid [H], ethambutol [E]) is an indicator of the NTP efficiency. We report results from a five-year survey among patients with new smear positive pulmonary tuberculosis. Acquired resistance is assessed among recurrent cases. During the first survey, carried out in 1994-1995 in four large cities, multidrug resistance (MDR) rate to the major antituberculosis drug H and R was low, 0.25% for primary MDR and 5% for acquired MDR. No primary MDR was found in Antananarivo; on the other hand, acquired resistance rate was the highest there (22%). Because of logistical reasons, the second survey (1999-2000) was only carried out in the capital, Antananarivo. Results obtained among 789 new patients with smear positive pulmonary tuberculosis and 79 recurrents cases in 9 diagnostic centres showed low primary and acquired resistance of 11.1% to any drug. Primary resistance to one drug was 10.6%, mainly due to streptomycin 8.5%. MDR rates are comparable with those observed in 1994-1995: 0.1% for primary MDR and 4% for acquired MDR. These results show that ten years after the new NTP implementation, only a few MDR strains are circulating in Antananarivo, which suggests that NTP has been effective.
Ratsirahonana
O
O
Laboratoire des Mycobactéries, Institut Pasteur de Madagascar, BP 1274-101 Antananarivo-Madagascar.
Rasolofo Razanamparany
V
V
Rasolonavalona
T
T
Rakotonirina
V
V
Rakotoarisaonina
A
A
Rakotoherisoa
A
A
Ralamboson
M
M
Cauchoix
B
B
Rakotondramarina
D
D
Ramarokoto
H
H
D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D023801:Directly Observed Therapy; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics*; D009313:National Health Programs; D011159:Population Surveillance; D011446:Prospective Studies; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D014504:Urban Health / Q000706:statistics & numerical data*
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin