title: Resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients.
abstract: BACKGROUND
  Fluoroquinolones are the backbone of multidrug resistant tuberculosis treatment regimens. Despite the high burden of multidrug resistant tuberculosis in the country, little is known about drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance among multidrug resistant tuberculosis patients from Pakistan.
  
  
  OBJECTIVE
  To evaluate drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients.
  
  
  METHODS
  This was a cross-sectional study conducted at a programmatic management unit of drug resistant tuberculosis, Lady Reading Hospital Peshawar, Pakistan. Two hundred and forty-three newly diagnosed multidrug resistant tuberculosis patients consecutively enrolled for treatment at study site from January 1, 2012 to July 28, 2013 were included in the study. A standardized data collection form was used to collect patients' socio-demographic, microbiological, and clinical data. SPSS 16 was used for data analysis.
  
  
  RESULTS
  High degree of drug resistance (median 5 drugs, range 2-8) was observed. High proportion of patients was resistant to all five first-line anti-tuberculosis drugs (62.6%), and more than half were resistant to second line drugs (55.1%). The majority of the patients were ofloxacin resistant (52.7%). Upon multivariate analysis previous tuberculosis treatment at private (OR=1.953, p=0.034) and public private mix (OR=2.824, p=0.046) sectors were predictors of ofloxacin resistance.
  
  
  CONCLUSIONS
  The high degree of drug resistance observed, particularly to fluoroquinolones, is alarming. We recommend the adoption of more restrictive policies to control non-prescription sale of fluoroquinolones, its rational use by physicians, and training doctors in both private and public-private mix sectors to prevent further increase in fluoroquinolones resistant Mycobacterium tuberculosis strains.
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. Electronic address: nafeesuob@gmail.com.
authors.forename: Nafees
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Department of Pulmonology, Postgraduate Medical Institute, Peshawar, Pakistan.
authors.forename: Arshad
authors.initials: A
authors.lastname: Javaid
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Syed Azhar Syed
authors.initials: SA
authors.lastname: Sulaiman
authors.affiliation: Unit for Medication Outcomes Research and Education, School of Medicine, Division of Pharmacy, University of Tasmania, Australia.
authors.forename: Long Chiau
authors.initials: LC
authors.lastname: Ming
authors.affiliation: Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.
authors.forename: Izaz
authors.initials: I
authors.lastname: Ahmad
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Amer Hayat
authors.initials: AH
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D010154:Pakistan; D015995:Prevalence; D018088:Tuberculosis, Multidrug-Resistant / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones
keywords: Fluoroquinolones; MDR-TB; Private; Resistance