Nationwide drug resistance survey of tuberculosis in the Philippines.
METHODS
The Philippines, one of the high tuberculosis (TB) burden countries.


OBJECTIVE
To determine the prevalence of anti-tuberculosis drug resistance in the first nationwide systematic survey.


METHODS
A population-proportionate cluster sampling method was employed. Smear-positive pulmonary TB patients aged > or = 15 years were eligible. Drug susceptibility testing was performed against four first-line drugs, i.e., isoniazid, rifampicin, ethambutol and streptomycin.


RESULTS
A total of 1091 patients were enrolled during a 17-month period starting in June 2003, of whom 935 (85.7%) were new cases and 121 (11.1%) previously treated cases. Resistance to any of the four drugs was seen in 20.4% (95%CI 18.1-22.9) of new cases, in 38.8% (95%CI 27.8-51.1) of previously treated cases and in 22.1% (19.7-24.9) of both new and previously treated cases combined. The prevalence of multidrug resistance was respectively 3.8% (95%CI 2.6-5.5), 20.9% (95%CI 13.0-32.0) and 5.7% (95%CI 4.3-7.5). The prevalence of drug resistance among new cases was higher than the global average and it was widespread throughout the country.


CONCLUSIONS
Confronted with the high prevalence of drug resistance, current efforts by the government to ensure better quality treatment programme should be strengthened.