Primary ethambutol resistance among Iranian pulmonary tuberculosis patients: a systematic review.
BACKGROUND
Ethambutol (EMB) is an anti-mycobacterial agent that is most commonly used in combination with other anti-tuberculosis (TB) drugs in the treatment of TB. Studies have shown that primary resistance rates ofMycobacterium tuberculosisto EMB vary widely, that is, from 1% to as high as 14%. In this study, we aimed to determine the exact prevalence of primary EMB resistance among pulmonary TB cases.


METHODS
Several databases, including Medline, Embase, and Iranian databases, were searched from March 2000 to January 2016 to identify studies addressing EMB-resistant TB in Iran. Comprehensive meta-analysis (V2.2, Biostat) software was used to analyze the data.


RESULTS
Of the 112 records identified from the databases, 10 studies fulfilled the eligibility criteria. The pooled prevalence of primary EMB-resistant TB was estimated at 4.2% [95% confidence interval (CI) 1.8-9.0]. No evidence of publication bias was observed among the included studies (p= 0.4 for Begg rank correlation analysis;p= 0.2 for Egger weighted regression analysis).


CONCLUSIONS
Results of systematic review and meta-analyses indicated that effective strategies to minimize the acquired drug resistance, to improve the drug susceptibility testing (DST) capability, and to control the transmission of resistance should be attached importance for control of TB in Iran.
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammad Javad
MJ
Nasiri
Applied Microbiology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Abbas Ali
AA
Imani Fooladi
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hossein
H
Dabiri
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ali
A
Pormohammad
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Alireza
A
Salimi Chirani
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Masoud
M
Dadashi
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hamidreza
H
Houri
Department of Microbiology, School of Medicine, Iran University of Medical Science, Tehran, Iran.
Mohsen
M
Heidary
Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Mehdi
MM
Feizabadi
Iran; ethambutol; meta-analysis; systematic review; tuberculosis