title: Drug resistance pattern in multidrug resistance pulmonary tuberculosis patients.
abstract: OBJECTIVE
  To evaluate the frequency of drug resistance profiles of multidrug resistant tuberculosis (MDR-TB) isolates of pulmonary tuberculosis patients, against both the first and the second line drugs.
  
  
  METHODS
  An observational study.
  
  
  METHODS
  The multidrug resistant tuberculosis (MDR-TB) ward of Ojha Institute of Chest Diseases (OICD), Karachi, from 1996 to 2006.
  
  
  METHODS
  Culture proven MDR-TB cases (resistant to both isoniazid and Rifampicin) were retrospectively reviewed. Susceptibility testing was performed at the clinical laboratory of the Aga Khan University. Sensitivity against both first and second line anti-tuberculosis drugs was done. Susceptibility testing was performed using Agar proportion method on enriched middle brook 7H10 medium (BBL) for Rifampicin, Isoniazid, Streptomycin, Ethambutol, Ethionamide, Capreomycin and Ciprofloxacin. Pyrazinamide sensitivity was carried out using the BACTEC 7H12 medium. During the study period MTB H37Rv was used as control.
  
  
  RESULTS
  Out of total 577 patients, all were resistant to both Rifampicin and Isoniazid (INH). 56.5% isolates were resistant to all five first line drugs. Resistances against other first line drugs was 76.60% for Pyrazinamide, 73% for Ethambutol and 68.11% for Streptomycin. Five hundred and ten (88%) cases were MDR plus resistant to one more first line drug. Forty (07%) isolates were MDR plus Quinolone-resistant. They were sensitive to Capreomycin but sensitivity against Amikacin and Kanamycin were not tested.
  
  
  CONCLUSIONS
  There were high resistance rates in MDR-TB to remaining first line and second line drugs. Continuous monitoring of drug resistance pattern especially of MDR isolates and treatment in specialized centers is a crucial need for future TB control in Pakistan.
authors.affiliation: Department of Pulmonology, Ojha Institute of Chest Diseases, Karachi. nisar.rao@aku.edu
authors.forename: Nisar Ahmed
authors.initials: NA
authors.lastname: Rao
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irfan
authors.forename: Mir Mir
authors.initials: MM
authors.lastname: Soomro
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Mehfooz
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004977:Ethambutol / Q000627:therapeutic use; D005000:Ethionamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis; D010154:Pakistan; D011718:Pyrazinamide / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000737:chemistry; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D005000:Ethionamide