title: Prevalence and drug resistance pattern of MDR TB in retreatment cases of Punjab, Pakistan.
abstract: OBJECTIVE
  To determine the prevalence and resistance pattern of multidrug-resistant tuberculosis.
  
  
  METHODS
  This cross-sectional study was carried out from January 2010 to June 2014 in nine tertiary care hospitals implementing programmatic management of drug-resistant tuberculosis in Punjab, and comprised retreatment tuberculosis cases. Data was collected from the Electronic Nominal Review System. SPSS 17 was used for data analysis.
  
  
  RESULTS
  Of the 1,250 cases, 861(69%) were of multidrug-resistant tuberculosis confirmed through drug sensitivity testing. The mean age was 32 (±13.5 SD) years. Besides, 664(53%) were males and 1,208(97%) resided in urban areas of Punjab. Multidrug-resistant tuberculosis was found to be more prevalent in the most productive age group, i.e. 15-45 years, with 709(57%) cases (p<0.05), in urban areas1, 208(97%) cases (p<0.05) and in the pulmonary site 852(68%) cases (p<0.05). Overall, 391(41%) cases showed resistance to all first-line anti-tuberculosis drugs while 239(28%) showed resistance to oral first-line drugs. Besides, 526(42%) cases showed resistance to fluoroquinolones and 650(52%) to second-line drugs. Of them, 420(81%), (p<0.05) patients showed highly significant resistance to fluoroquinolones and 26(5%) to ethionamide.
  
  
  CONCLUSIONS
  There is a need to fully implement national tuberculosis guidelines with a focus on expansion and effective implementation of directly observed therapy short course in order to prevent further emergence of drug resistance.
authors.affiliation: Provincial TB Control Program, Punjab, DGHS, Lahore, Pakistan.
authors.forename: Abdul Majeed
authors.initials: AM
authors.lastname: Akhtar
authors.affiliation: Medical Faculty Bioistatistic Division, Trakya University, Edirne, Turkey.
authors.forename: Muhammad Awais
authors.initials: MA
authors.lastname: Arif
authors.affiliation: Provincial TB Control Program, Punjab, DGHS, Lahore, Pakistan.
authors.forename: Shamsa
authors.initials: S
authors.lastname: Kanwal
authors.affiliation: Food and Nutrition Department, College of Home Economics, Lahore, Pakistan.
authors.forename: Sadia
authors.initials: S
authors.lastname: Majeed
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005000:Ethionamide; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000502:physiology*; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D019233:Retreatment; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones; D005000:Ethionamide
keywords: Multi Drug Resistance, Retreatment Cases, Prevalence, ENRS, PMDT.