ST PREVALENCE OF RESISTANCE TO 1 LINE ANTI TUBERCULOSIS DRUGS AT RAHIM YAR KHAN 1 1 1 1 1 Masood ul Haq, Abdul Salam, Imran Bashir, Muhammad Ahmad, Hafiz Muhammad Rizwan, 1 1 Arsalan Ahmad Khan Durrani, Rana Nasir Ali ABSTRACT Background: Tuberculosis is an important infectious health issue and its control strongly rely upon effective treatment. The drug resistance and its pattern are important determinant of the treatment regimen, its duration and outcome. Objective: To determine the frequency and pattern of drug resistance among 1st line anti tuberculosis treatment. Methodology: It was a cross sectional st study carried on 100 cases of smear positive TB. This study was conducted from 1 January 2010 to 30 June 2011. Detailed demographic data and history of ATT was taken and their sputa were sent for drug susceptibility testing on LJ media. The cases with drug resistance and no previous history of ATT were labeled as primary while those with previous history of ATT were labeled as secondary resistant cases. The data was entered and analyzed by using SPSS version 15. Results: Out of 100 patients enrolled, drug susceptibility report was available for 87 isolates as sputum failed to grow any organism in 13 patients. Out of these 87 cases, 48 (55.17%) were males and 39 (44.83%) females with age range of 9-91 years. Seventeen out of 87 patients (19.5%) had previous history of ATT. Out of 87 isolate, 62 (71.26%) were sensitive to all 1st line drugs (R, H, E, Z, S) while 25 (28.74%) were resistant to one or more drugs. Primary resistance was seen in 17 (24%) out of 70 cases in contrast to secondary in 8 (47%) out 17. The difference between primary and secondary resistance among various drugs was statistically significant for isoniazid (p value 0.003) and pyrazinamide (p value 0.036) while the difference to streptomycin, ethambutol and rifampicin was insignificant with p values of 0.20, 0.35 and 0.09 respectively. There was no case of primary MDR-TB and 5.9% of secondary MDR-TB. None of the sociodemographic parameter was significantly associated with drug resistance. Conclusion: Resistance st to 1 line anti-tuberculosis drugs at Rahim Yar Khan is still common. There are good number of patients in which this resistance pattern compromise the currently recommended regimens. However, larger surveillance studies are needed to strengthen this evidence. Key words: 1st line ATT, Drug resistance, MDR-TB, Tuberculosis. JSZMC 2016;7(3):988-992 INTRODUCTION Drugs Resistant tuberculosis (TB) remained the 1 biggest threat to control of the disease. A st combination of effective 1 line anti-tuberculosis drugs i.e. Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E) and Streptomycin (S) not only ensure cure of an individual patient but also stop spread of disease in the community. Emergence of drug resistance is influenced by a number of factors like poor prescribing practices of treating doctors, noncompliance of patients, poor quality, non- 1-3 availability and adverse effects of drugs etc. In a particular society, presence of such adverse factors will determine the frequency and severity of drug resistance to anti-tuberculosis drugs. As these factors differ from country to country and even in different localities of same country so 4,5 should be the pattern of resistance to these drugs. This fact is quite evident in the 4 reports published by the Global Project on Anti-Tuberculosis Drug 6-9 Resistance Surveillance since 1994. According to 4th global anti-tuberculosis drug resistance report by WHO, resistance to at least one anti tuberculosis drug ranged from 0% in Iceland to 56.3% in Baku, Azerbaijan. The proportion of MDR ranged from 0% in eight countries to 19.4% in the Republic of Moldova and 22.3% in Baku, Azerbaijan. A retrospective review of data from Cape Town, South Africa presented at the IUATLD World Conference on Lung Health. 8-12 November 2007 showed that overall 5.6% of 17, 615 MDR isolates collected from 2004 to 2007 were XDR-TB, however, the figures differed across various provinces with KwaZulu- Natal reporting as high as 14% of MDR cases as 9 XDR-TB. In developed world, drugs susceptibility testing (DST) is done on all isolates of Mycobacterial TB responsible for human disease and treatment is 10,11 guided by these DST results. However, in developing world where disease is more prevalent, such costly and time consuming practices are not feasible due to lack of financial resources. Therefore, Original Article JSZMC Vol.7 No.3 988 1.Department of Pulomonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, University of Health Sciences Lahore, Pakistan. Correspondence: Dr. Masood ul Haq, Associate Professor, Department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan. E-mail: masoodulhaq_pk@yahoo.com Mobile:+92-3347324576 Received: 01-07-2016 Accepted: 10-07-2016