title: Screening outcomes from patients with suspected multidrug-resistant tuberculosis: lessons learned in the Philippines.
abstract: METHODS
  The high prevalence of multidrug-resistant tuberculosis (MDR-TB) in the Philippines is a challenge for the National TB Programme.
  
  
  OBJECTIVE
  To assess patterns of drug resistance and screening outcomes among MDR-TB suspects evaluated from 2003 to 2008 at DOTS-Plus clinics  in the Philippines.
  
  
  METHODS
  Descriptive study of 4897 consecutive patients with suspected MDR-TB.
  
  
  RESULTS
  The median time from the first visit until a diagnosis of drug-resistant TB was 132 days (IQR 110-166 days). Among patients screened for MDR-TB, the most frequent resistance  pattern among those previously treated in DOTS facilities was resistance to isoniazid (INH) and rifampicin (RMP). Resistance to INH+RMP plus fluoroquinolones was the most common pattern among those who had failed Category II treatment and patients treated by non-DOTS facilities. Among patients  with MDR-TB, 57% ultimately received appropriate treatment with second-line drugs. The remaining 43% were lost to follow-up (25%), died (14%) or refused treatment (4%).
  
  
  CONCLUSIONS
  Resistance to INH+RMP is the most frequent resistance pattern among patients referred from DOTS clinics in  the Philippines for suspected MDR-TB. Initial use of standard regimens based on national survey data and quick uptake of new rapid molecular resistance tests may be useful to reduce diagnostic delays and expedite treatment for drug-resistant TB.
authors.affiliation: Tropical Disease Foundation, Makati City, Philippines. tarcelasg@yahoo.com
authors.forename: M T
authors.initials: MT
authors.lastname: Gler
authors.forename: R S
authors.initials: RS
authors.lastname: Guilatco
authors.forename: C V
authors.initials: CV
authors.lastname: Guray
authors.forename: T E
authors.initials: TE
authors.lastname: Tupasi
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010679:Philippines / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents