title: Pattern of first- and second-line drug resistance among pulmonary tuberculosis retreatment cases in Pakistan.
abstract: Drug resistance in general, and multidrug-resistant tuberculosis (MDR-TB) in particular, threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Pakistan.
  
  
  
  To obtain population-based data on Mycobacterium tuberculosis drug resistance in Pakistan.
  
  
  
  To obtain drug resistance data, we conducted a population-based study of TB cases in all provinces of Pakistan. We performed culture and drug susceptibility testing on M. tuberculosis isolates from patients with a prior history of anti-tuberculosis treatment (retreatment cases) from all over the country.
  
  
  
  Of 544 isolates from previously treated cases, 289 (53.1%) were susceptible to all first-line drugs, 255 (46.9%) were resistant to at least one anti-tuberculosis drug and 132 (24.3%) were MDR-TB. Among MDR-TB isolates, 47.0% were ofloxacin (OFX) resistant. Extensively drug-resistant TB was found in two (0.4%) isolates.
  
  
  
  Prevalence of drug resistance in retreatment isolates was high. The alarmingly high prevalence of OFX resistance among MDR-TB isolates may threaten the success of efforts to control and treat MDR-TB.
authors.affiliation: Department of Pulmonology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar.
authors.forename: A
authors.initials: A
authors.lastname: Javaid
authors.affiliation: Department of Microbiology, Agha Khan University, Karachi.
authors.forename: R
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Department of Microbiology, Agha Khan University, Karachi.
authors.forename: A
authors.initials: A
authors.lastname: Zafar
authors.affiliation: Gulab Devi Chest Hospital, Lahore.
authors.forename: M A
authors.initials: MA
authors.lastname: Chaudry
authors.affiliation: Ojha Institute of Chest Disease, Karachi.
authors.forename: S
authors.initials: S
authors.lastname: Qayyum
authors.affiliation: National TB Control Programme, Islamabad.
authors.forename: E
authors.initials: E
authors.lastname: Qadeer
authors.affiliation: Department of Pulmonology, Nishtar Medical College, Multan.
authors.forename: Z
authors.initials: Z
authors.lastname: Shaheen
authors.affiliation: Fatima Jinnah Chest Hospital, Quetta.
authors.forename: N
authors.initials: N
authors.lastname: Agha
authors.affiliation: Department of Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: N
authors.initials: N
authors.lastname: Rizvi
authors.affiliation: Khyber Medical College, Peshawar.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Afridi
authors.affiliation: Department of Pulmonology, Services Hospital, Lahore.
authors.forename: M K
authors.initials: MK
authors.lastname: Chima
authors.affiliation: Department of Pulmonology, Ayub Medical College, Abbottabad.
authors.forename: A R
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Health Department, Peshawar.
authors.forename: A
authors.initials: A
authors.lastname: Ghafoor
authors.affiliation: Department of Chest Medicine, Lahore General Hospital, Lahore.
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.affiliation: Itefaq Medical College, Lahore.
authors.forename: S R
authors.initials: SR
authors.lastname: Awan
authors.affiliation: Department of Medicine, Ziauddin University, Karachi.
authors.forename: S
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Department of Pulmonology, King Edward Medical University, Lahore.
authors.forename: K
authors.initials: K
authors.lastname: Choudry
authors.affiliation: Department of Pulmonology, Allama Iqbal Medical College, Lahore.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Iqbal
authors.affiliation: Orthopaedic and Medical Institute, Karachi, Pakistan.
authors.forename: M
authors.initials: M
authors.lastname: Ansarie
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: N
authors.initials: N
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D015242:Ofloxacin / Q000494:pharmacology; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D019233:Retreatment; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D015242:Ofloxacin