SUSCEPTIBILITY PATTERN OF 2ND LINE ANTI TUBERCULOSIS DRUGS AT RAHIM YAR KHAN

Abstract

Background: Pakistan has a high burden of drug resistant TB. Effective management of these cases needs the inclusion of 2nd line
anti-tuberculosis drugs. A comprehensive knowledge of susceptibility pattern to these drugs is mandatory to formulate the best
possible regimen. Objective: To determine the susceptibility pattern of 2nd line anti tuberculosis drugs. Methodology: This cross
sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on
smear positive cases of PTB. This study was conducted from 1st March 2010 to 30th April 2011. A total of 64 smear positive
tuberculosis patients of any age and sex regardless of previous treatment with 1st line ATT & no history of prior exposure to 2nd line
ATT were included. Sociodemographic data like age, sex, marital status and income were recorded. Early morning sputum
samples were cultured on LJ medium at a reference lab. Drug susceptibility testing (DST) was done for ethionamide, amikacin,
kanamycin, capreomycin and ofloxacin to determine the presence of resistance. The data was analyzed on SPSS version 15.
Results: In this study, out of total 64 cases, 36 (56.25%) were males and 28 (43.75%) females with age range of 9 to 76 years.
Thirteen cases (20.31%) had previous exposure to 1st line ATT. Twelve (18.8%) were resistant to one or more drugs. Resistance
was highest for ofloxacin (14.1%) followed by ethionamide (6.3%), capreomycin (3.1%), amikacin (1.6%) and kanamycin
(1.6%). Sociodemographic characteristics also did not show any statistically significant association with drug resistance.
Conclusion: There is high frequency of resistance to ofloxacin and ethionamide. To avoid addition of further resistance, DST
should be available as early as possible by conventional methods or by rapid genotypic methods at the start of treatment.