title: Systematic review of the prevalence of Mycobacterium tuberculosis resistance in Saudi Arabia.
abstract: OBJECTIVE
  To quantitatively estimate the prevalence of resistance of Mycobacterium tuberculosis (TB) to first line agents in Saudi Arabia.
  
  
  METHODS
  The overall prevalence of M. tuberculosis resistance was calculated using meta-analysis.
  
  
  RESULTS
  We included 22 studies from Saudi Arabia that were published from 1979 to 2013.A high degree of heterogeneity among studies was observed. Based on random effect methodology, the prevalence (and 95% CI) of the resistance rates were: INH 10.13 (8.13-12.11), rifampicin 5.41 (4.21-6.61), ethambutol 1.29 (1.83-2.37) and streptomycin 6.5 (4.9-8.1), and multi-drug resistant was 6.7 (5.1-8.3).
  
  
  CONCLUSIONS
  The prevalence of resistance to anti-tuberculous agents was highest for INH followed by streptomycin and rifampicin. Multi-drug resistant tuberculosis remains at 6.7%. The data support the recommendations to use four anti-tuberculous agents as empiric therapy.
authors.affiliation: Johns Hopkins Aramco Healthcare , Dhahran, Kingdom of Saudi Arabia.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.forename: Kareem
authors.initials: K
authors.lastname: Hinedi
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology*; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D015995:Prevalence; D012293:Rifampin / Q000494:pharmacology*; D012529:Saudi Arabia / Q000453:epidemiology; D013307:Streptomycin / Q000494:pharmacology*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin
keywords: Resistance; Saudi Arabia; Systematic review; Tuberculosis