A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance
Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were to determine M. tuberculosis susceptibility and document management after receipt of...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2015-01-01
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| Series: | Journal of Tropical Medicine |
| Online Access: | http://dx.doi.org/10.1155/2015/261925 |
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| Summary: | Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of
Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were
to determine M. tuberculosis susceptibility and document management after receipt of
susceptibility results. Methods. Prospective study of adult outpatients with smear-positive
pulmonary tuberculosis (PTB) in Sabah, Malaysia. Additionally, hospital clinicians accessed the
reference laboratory for clinical purposes during the study. Results. 176
outpatients were enrolled; 173 provided sputum samples. Mycobacterial culture yielded M. tuberculosis in
159 (91.9%) and nontuberculous Mycobacterium (NTM) in three (1.7%). Among
outpatients there were no instances of multidrug resistant M. tuberculosis (MDR-TB).
Seven people (4.5%) had isoniazid resistance (INH-R); all were switched to an appropriate
second-line regimen for varying durations (4.5–9 months). Median delay to commencement
of the second-line regimen was 13 weeks. Among 15 inpatients with suspected TB, 2 had multidrug
resistant TB (one extensively drug resistant), 2 had INH-R, and 4 had NTM. Conclusions. Current
community rates of MDR-TB in Sabah are low. However, INH-resistance poses challenges, and NTM is an
important differential diagnosis in this setting, where smear microscopy is the usual diagnostic modality. To
address INH-R management issues in our setting, we propose an algorithm for the treatment of isoniazid-resistant PTB. |
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| ISSN: | 1687-9686 1687-9694 |