title: Surveillance of anti-tuberculosis drug resistance in Ernakulam District, Kerala State, South India.
abstract: METHODS
  This is the first report on drug resistance surveillance (DRS) in Ernakulam District, Kerala, South India, based on a standard protocol from World Health Organization (WHO) guidelines.
  
  
  OBJECTIVE
  To determine the level of drug resistance among smear-positive pulmonary tuberculosis (PTB) patients with no history of previous treatment in Ernakulam District, Kerala State.
  
  
  METHODS
  Two additional sputum samples were collected from all consecutive new smear-positive PTB cases registered under the revised National TB Control Programme (RNTCP) formulated by the Government of India. The generic protocol developed by the Central TB Division for district level DRS in accordance with WHO guidelines was followed. Training of laboratory staff and other health personnel, periodic monitoring and quality assurance of laboratory work were carried out by the Tuberculosis Research Centre, Chennai.
  
  
  RESULTS
  A total of 305 (88.7%) sputum samples were positive for culture. Resistance to any drug was seen in 27.9% and multidrug-resistant tuberculosis (MDR-TB) was observed in 2%. Monoresistance to rifampicin and streptomycin was observed in respectively 1% and 17% of cases, and 27.1% resistance was observed to any drug in the younger age group.
  
  
  CONCLUSIONS
  MDR-TB is within expected ranges in Ernakulam District. Further studies that include the private sector are needed in the state among different age groups.
authors: Department of Community Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Kochi, Kerala, India. marina.rajan@gmail.com
authors: M R
authors: MR
authors: Joseph
authors: C T
authors: CT
authors: Shoby
authors: G R
authors: GR
authors: Amma
authors: L S
authors: LS
authors: Chauhan
authors: C N
authors: CN
authors: Paramasivan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000517:prevention & control