Primary Drug Resistance to Antituberculous drugs in Punjab Pakistan

Arshad Javaid, Shamshad R Awan, Zafar A Syed, Zafar H Iqbal, Chaudhary M Akram, Karam Shah, Zubair Shaheen, Saulat Ullah Khan, Rumina Hasan, Afia Zafar


Objective: To assess the prevalence of Primary drug resistance in Punjab
Introduction/ Methods: Tuberculosis is a serious public health problem. Pakistan ranks 6th in terms of TB burden with a WHO estimated incidence rate of 181 per 100,000 persons. This study was a cross-sectional prevalence study, evaluating the prevalence of drug resistance among new TB patients, using a non-probability convenience sampling methodology. The sample size was calculated according to the population & WHO’s estimated incidence of smear positive tuberculosis in the province/country. Sputum samples were obtained from 430 newly diagnosed patients of pulmonary tuberculosis from various centres in Lahore, Rawalpindi & Multan.
Results: Sensitivities were performed by proportion method which showed the following resistance values in 387 eligible patients. 42 (10.8 %) samples showed primary resistance to one or more drugs. 28 (7.2%) of the isolates tested were resistant to a single drug, 8 (2.0%) were resistant to 2 drugs, 2 (0.5%) to 3 drugs, 3 (0.75%) to 4 drugs while one (0.25%) to all 5 first line agents.
*Department of Pulmonology, PGMI, Lady Reading Hospital Peshawar, ** King Edward Medical University
Lahore, ***Nishtar Medical College Multan, +Allama Iqbal Medical Lahore, ++Gulab Devi Hospital Lahore,
++National TB Control Program, ++++Department of Microbiology Agha Khan University Hospital Karachi.
Resistance to Streptomycin (10μg/ml) was seen in 19 (5.9%), Isoniazid (1μg/ml) in 27
(7.0%), Rifampicin (5μg/ml) in 5 (1.2%), Ethambutol (10μg/ml) in 9 (2.3%) and
Pyrazinamide in 7 (1.8%) samples. Primary Multidrug resistance was in 4 (1.0 %)
patients (Isoniazid 1μg/ml, rifampicin 5 μg/ml with or without other drugs).
Conclusion: This study from province wide samples suggests that prevalence of MDR
amongst untreated patients in Punjab is 1.0%, which is a cause of concern and should
be addressed through effective TB control programs with DOTS strategy.


Primary drug resistance; Pulmonary Tuberculosis (PTB); MDR-TB; Punjab.

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