title: Availability of second-line drugs and anti-tuberculosis drug susceptibility testing in China: a situational analysis.
abstract: OBJECTIVE
  To assess the availability of second-line drugs (SLDs) and the use of drug susceptibility testing (DST) results for the treatment of tuberculosis (TB) in China.
  
  
  METHODS
  Cross-sectional survey in 4675 health care facilities, 1960 of which have a dedicated TB clinic, in 12 provinces in China.
  
  
  RESULTS
  More than 70% of TB clinics at the provincial and prefecture levels had at least one SLD available compared to 41.8% of facilities at the county/district level. The proportion of facilities at provincial, prefecture and county levels with any fluoroquinolone was respectively 74.1%, 64.9% and 34.5%. Sputum culture was performed at 6.0% of TB clinics at the county level, 37.5% at the prefecture and 59.3% at the provincial levels, while DST was performed only at the prefecture (28.6%) and provincial (44.4%) levels. Only 18% of the facilities that used SLDs for the treatment of multidrug-resistant TB (MDR-TB) based treatment regimens on DST results.
  
  
  CONCLUSIONS
  SLDs are widely available in China for the treatment of both TB and other infectious diseases. To prevent the development of Mycobacterium tuberculosis resistance to SLDs, the availability of SLDs should be limited and they should be used with caution in the treatment of MDR-TB.
authors.affiliation: National Center for TB Control and Prevention, China Center for Disease Control and Prevention, Beijing, China. heguangxue@chinatb.org
authors.forename: G X
authors.initials: GX
authors.lastname: He
authors.forename: S
authors.initials: S
authors.lastname: van den Hof
authors.forename: M W
authors.initials: MW
authors.lastname: Borgdorff
authors.forename: M J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: S M
authors.initials: SM
authors.lastname: Cheng
authors.forename: Y L
authors.initials: YL
authors.lastname: Hu
authors.forename: L X
authors.initials: LX
authors.lastname: Zhang
authors.forename: L X
authors.initials: LX
authors.lastname: Wang
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology* / Q000600:supply & distribution; D002681:China; D003430:Cross-Sectional Studies; D024841:Fluoroquinolones / Q000494:pharmacology; D019538:Health Care Surveys; D006801:Humans; D008826:Microbial Sensitivity Tests; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones