[Ip-health] Lancet: Updated Analysis of antituberculosis drug resistance

[Ira Glazer]

http://www.thelancet.com/journals/lancet/article/PIIS0140673606698632/abstr=
act

The Lancet 2006; 368:2142-2154
DOI:10.1016/S0140-6736(06)69863-2

Epidemiology of antituberculosis drug resistance (the Global Project on
Anti-tuberculosis Drug Resistance Surveillance): an updated analysis

Summary

Background

The burden of tuberculosis is compounded by drug-resistant forms of the
disease. This study aimed to analyse data on antituberculosis drug
resistance gathered by the WHO and International Union Against
Tuberculosis and Lung Disease Global Project on Anti-tuberculosis Drug
Resistance Surveillance.

Methods

Data on drug susceptibility testing for four antituberculosis
drugs=97isoniazid, rifampicin, ethambutol, and streptomycin=97were gathered
in the third round of the Global Project (1999=962002) from surveys or
ongoing surveillance in 79 countries or geographical settings. These
data were combined with those from the first two rounds of the project
and analyses were done. Countries that participated followed a
standardised set of guidelines to ensure comparability both between and
within countries.

Findings

The median prevalence of resistance to any of the four antituberculosis
drugs in new cases of tuberculosis identified in 76 countries or
geographical settings was 10=B72% (range 0=B70=9657=B71). The median preval=
ence
of multidrug resistance in new cases was 1=B70% (range 0=B70=9614=B72).
Kazakhstan, Tomsk Oblast (Russia), Karakalpakstan (Uzbekistan), Estonia,
Israel, the Chinese provinces Liaoning and Henan, Lithuania, and Latvia
reported prevalence of multidrug resistance above 6=B75%. Trend analysis
showed a significant increase in the prevalence of multidrug resistance
in new cases in Tomsk Oblast (p<0=B70001). Hong Kong (p=3D0=B701) and the U=
SA
(p=3D0=B70002) reported significant decreasing trends in multidrug
resistance in new cases of tuberculosis.

Interpretation

Multidrug resistance represents a serious challenge for tuberculosis
control in countries of the former Soviet Union and in some provinces of
China. Gaps in coverage of the Global Project are substantial, and
baseline information is urgently required from several countries with
high tuberculosis burden to develop appropriate control interventions.