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Resistance to Second-Line TB Drugs Is Common Globally

Last Updated: August 30, 2012.

Nearly half of patients with tuberculosis in eight countries show resistance to at least one second-line drug, with previous treatment with second-line drugs strongly associated with resistance to these drugs and with extensively drug-resistant tuberculosis, according to a study published online Aug. 30 in The Lancet.

THURSDAY, Aug. 30 (HealthDay News) -- Nearly half of patients with tuberculosis in eight countries show resistance to at least one second-line drug, with previous treatment with second-line drugs strongly associated with resistance to these drugs and with extensively drug-resistant (XDR) tuberculosis, according to a study published online Aug. 30 in The Lancet.

Tracy Dalton, Ph.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues examined resistance to second-line antituberculosis drugs among 1,278 patients from Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea, and Thailand. To identify risk factors for resistance to second-line drugs and XDR tuberculosis, the results were compared with clinical and epidemiological data.

The researchers found that 43.7 percent of patients showed resistance to at least one second-line drug, with 20.0 percent showing resistance to at least one second-line injectable drug and 12.9 percent to at least one fluoroquinolone. A total of 6.7 percent of patients had XDR, which ranged from 0.8 to 15.2 percent across study sites. The strongest risk factor for resistance to second-line drugs was previous treatment with second-line drugs, which was linked with more than a four-fold increase in the risk of XDR tuberculosis. Women more frequently experienced fluoroquinolone resistance and XDR tuberculosis, compared with men. Resistance to second-line injectables was correlated with unemployment, alcohol abuse, and smoking.

"Previous treatment with second-line drugs is a strong, consistent risk factor for resistance to these drugs, including XDR tuberculosis," the authors write. "Representative drug-susceptibility results could guide in-country policies for laboratory capacity and diagnostic strategies."

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