title: Mycobacterium tuberculosis resistance pattern against first-line drugs in patients from urban area.
abstract: OBJECTIVE
  Tuberculosis (TB) infection is still a major public health burden in Indonesia. TB cases in Indonesia constitute 35% of all the TB cases detected worldwide and the prevalence of TB drug resistance in this country is approximately 3%. The aim of this study was to evaluate the resistance of Mycobacterium tuberculosis to first-line TB drugs among isolates from clinical specimens from a hospital in an urban area.
  
  
  METHODS
  This laboratory-based study was conducted in Tangerang District, Indonesia, from January 2011 to December 2014. Sputum and other clinical specimens were obtained from patients with pulmonary and extrapulmonary TB. The specimens were stained with Ziehl-Neelsen, inoculated on Löwenstein-Jensen media for 6-8 weeks, and tested for sensitivity against first-line TB drugs [isoniazid (INH), rifampicin (RIF), ethambutol (EMB), and streptomycin (SM)].
  
  
  RESULTS
  All TB patients in this study lived in urban areas with male preponderance. Of the 127 M. tuberculosis isolates collected, 22% showed resistance to first-line TB drugs. Among these resistant isolates, 20.5% showed resistance to at least one of the first-line TB drugs and 0.8% showed multidrug resistance (MDR). Resistance to EMB, INH, RIF, and SM was seen in 6.3% 6.3%, 4.7%, and 1.6% of isolates, respectively. Polyresistance to EMB and INH, EMB and RIF, and EMB, INH, and RIF was seen in 0.8% of the isolates, respectively.
  
  
  CONCLUSIONS
  Our study confirms that drug resistance, including MDR, observed against all first-line TB drugs was a real threat in the management of TB infection in Indonesia. The resistance pattern identified in this study could assist clinicians in providing appropriate treatment regimen to TB patients and improve their clinical outcome.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia. Electronic address: cucunawangsih.fk@uph.edu.
authors.lastname: Cucunawangsih
authors.affiliation: Department of Microbiology, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Wiwing
authors.affiliation: Department of Respirology, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia.
authors.forename: Allen
authors.initials: A
authors.lastname: Widysanto
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia.
authors.forename: Nata Pratama Hardjo
authors.initials: NP
authors.lastname: Lugito
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology; D014504:Urban Health
chemical_list: D000995:Antitubercular Agents
keywords: First-line TB drugs; Resistance; Tuberculosis; Urban area