耐多药肺结核患者痰菌耐药不均一性研究初报

目的 采用新的实验方法探讨耐多药肺结核患者痰菌是否存在耐药不均一性。方法 一例耐多药肺结核思者痰分离培养物制成的菌悬液，用8．0μm孔径醋酸纤维膜过滤得到单条结核菌分散存在的菌悬液，稀释后接种培养，挑取24个单菌落，分别传代培养获得24个结核菌的纯种。采取中国标准绝对浓度法对24个纯种菌株进行药物(INH、RFP、SM、EMB))敏感性试验，以敏感株H37Rv为对照。结果 从耐多药肺结核患者的分离株得到的24个纯种结核菌中，对INH敏感1个(4．2％)、低耐22个(91．6％)、高耐1个(4．2％)；对RFP敏感2个(8．3％)、低耐2个(8．3％)、高耐20个(83．4％)；对SM敏感1个(4．2％)、低耐0个(0％)、高耐23个(95．8％)；对EMB全部敏感。结论 耐多药肺结核患者的痰菌对多种抗结核药物均存在耐药不均一性，敏感菌与耐药菌、低耐菌与高耐菌混合存在，敏感菌为极少数，耐药菌占绝大多数。     

耐药肺结核病人治疗现况研究

目的 探讨初始耐药与获得性耐药肺结核病人的情况与治疗效果，对初始与获得性耐药肺结核病人的管理与治疗提供参考依据。方法 肺结核患者的痰标本用L-J培养基进行结核分枝杆菌分离培养，对全部阳性菌株用PNB进行人型与牛型、结核与非结核分枝杆菌的菌种的鉴定。采用比例法检测分离的结核分枝杆菌菌株对抗结核药物的敏感性。分析完成规定疗程的耐药肺结核病人225例的耐药与治疗情况。结果 初始耐药肺结核病人149例，其中耐单药87例，耐多药62例；耐单药者中耐SM占41．38％，耐INH占39．08％，耐RFP占13．79％，耐EMB占5．79％；初始耐药病人耐多药者中耐HR占37．1％，耐HRES占29．0％，耐HRS占21．0％，耐HRE占12．9％。获得性耐药肺结核病人76例，其中耐单药者38人，耐SM占39．48％，耐INH占34．21％，耐RFP占21．05％，耐EMB占5．26％；获得性耐多药38例，耐HR占52．6％；耐HRES占21．1％，耐HRS占。18．4％，耐HRE7．9％。初始耐单药肺结核病人治愈率94．25％；耐多药肺结核病人治愈率88．7％；获得性耐单药肺结核病人治愈率92．1％，耐多药肺结核病人治愈率63．2％。结论 初始与获得性耐药肺结核病人的耐单药发生率排序一致，依次为SM、INH、RFP及EMB。初治与获得性耐多药肺结核病人的耐多药排序亦相同，依次为HR、HRES、HRS及HRE。研究结果提示，对耐单药的肺结核病人应用现有的短程化疗方案，仍可获得较好的治疗效果，而耐多药肺结核病人应用现有的短程化疗方案的治疗效果则较差。控制耐药的关键是积极治疗传染性耐药结核病患者，降低原发耐药率与继发耐药率。     

初始耐药与短程化疗关系探讨

96例初始耐药肺结核病例,经6个月化疗后的失败率高达11.4％。分析初始耐药与短化疗效的相关因素:①对利福类药物是否耐药。对R耐药者失败率为33.3％,敏感者仅5.4％。②耐方案中药物的种类。强化期联用3药者,耐2药的失败率55.6％,耐1药仅7.1％;联用4药者,耐3药的失败率33.3％,耐1～2药仅2.9％。③方案组合的强弱,耐方案中1～2药者在不含Z方案中的失败率22.2％,在含Z方案中仅2.9％。均有显著差异。     

228例初治培阳肺结核病人短化疗效与耐药性分析

目的 分析228例初治培阳肺结核病人其耐药性与短化疗效的关系。方法 病人治疗采用全程隔日间歇短化方案,（2R3H3E3Z3／4R3H3）。采用绝对浓度法进行药敏测定。结果 33例初治耐药肺结核病例,经6个月正规短程化疗失败率高达12．1％。（1）对耐R类药物者化疗失败率为40％（2／5）,敏感组化疗失败率为2．6％（5／195）,两组有显著性差异（P＜0．05）;（2）对其他类（不含耐R类）化疗失败率为7．1％,与敏感组比较无显著性差异（P＞0．05）。二年随访耐药组细菌复发率为3．5％,敏感组细菌复发率为1．1％。结论 药物敏感病例和耐1种或2种药的病例（不含耐R类）采用6个月短程化疗方案是合理有效的。     

漳州市复治耐药肺结核的临床和病原学分析

目的了解漳州市复治耐药肺结核的临床特征和病原学情况。方法经对复治肺结核患者的晨痰、胸液进行分枝杆菌培养、鉴定和抗结核药物敏感性试验。结果11例复治肺结核患者中，2例规则抗结核治疗，9例抗结核药物未满疗程。均为继发性肺结核，8例为结核分枝杆菌感染，1例“复治肺结核”为非结核分枝杆菌病。8例复治培阳肺结核患者均有不同程度耐药。耐多药5例，耐药种类3—10种。所有耐药菌株中发现2株为利福平依赖菌。结论复治肺结核多表现有空洞、肺毁损，易继发感染、合并糖尿病、肺心病。不规则用药是导致复治和耐药的最常见原因。耐药率为72．7％，肺结核耐多药率达62．5％。对漳州复治肺结核患者有必要广泛开展结核分枝杆菌培养、鉴定和药物敏感性试验，更利于医疗、防疫人员循证科学施治，对预防耐药肺结核发生和减少耐药肺结核的社区传播具有重要意义。     

结核菌初始耐药对肺结核短化的影响

初始耐药菌组及敏感菌组肺结核病例的短程化疗结束，痰菌阴转率分别为８８．５％及９８．８％，２年细菌学复发率分别为８．５％及１．３％。耐１药者失败率为２．１％，耐２药及耐３药各为１４．８％及４１．７％，耐ＲＦＰ的失败率为２１．４％，说明，初始耐药，尤以耐ＲＦＰ者，是短化失败主要原因。     

结核菌初始耐药对肺结核短化的影响

初始耐药菌组及敏感菌组肺结核病例的短程化疗结束，痰菌阴转率分别为８８．５％及９８．８％。２年细菌学复发率分别为８．５％及１．３％。耐１药者失败率为２．１％，耐２药及耐３药各为１４．８％及４１．７％。耐ＲＦＰ的失败率为２１．４％。说明，初始耐药，尤以耐ＲＦＰ者，是短化失败主要原因。     

上海市流动人口的结核病耐药状况及相关因素分析

目的了解上海市流动人口的结核病耐药状况及相关因素，为制定流动人口的结核病控制策略提供依据。方法将上海市各区县结核病定点医院2004年2月至2005年1月诊治的流动人口中所有新发及复治的痰培养阳性肺结核病例作为研究对象，并对所有分离培养阳性菌株进行菌型鉴定及利福平、异烟肼、链霉素及乙胺丁醇敏感性测试，分析流动人口耐药结核病的流行状况及相关因素。结果共入选493例培养阳性肺结核患者，最后获得431例（占87．4％）患者的菌型鉴定及药敏结果，其中结核分枝杆菌427例（占99．1％），非结核分枝杆菌4例（占0．9％）。肺结核患者的总耐药率为18．3％（78／427），耐多药率为5．9％（25／427）；新发患者的耐药率为16．0％（62／387），耐多药率为4．1％（16／387）；复治患者的耐药率为40．0％（16／40），耐多药率为22．5％（9／40）。经单因素及多因素分析，45—60岁年龄组及复治病例是耐药及耐多药结核病的相关因素。结论上海市流动人口的结核病耐药率较高，今后要根据流动人口的特点加强防治措施。     

耐多药肺结核病人痰菌耐药不均一性研究报告

目的　探讨耐多药肺结核病人痰菌是否存在耐药不均一性。方法　取 1例耐多药肺结核病人痰分离培养物制成的菌悬液 ,用 8 0 μm孔径醋酸纤维膜过滤得到单条结核菌分散存在的菌悬液 ,稀释后接种培养 ,挑取2 4个单菌落 ,再分别传代培养获得 2 4个结核菌的纯种。再采取中国标准绝对浓度法对 2 4个纯种菌株进行药物(INH、RFP、SM、EMB)敏感性试验 ,以敏感株H37Rv为对照。结果　从耐多药肺结核病人的分离株得到的 2 4个纯种结核菌中 ,对INH敏感 1个 ( 4 2 % )、低耐 2 2个 ( 91 6% )、高耐 1个 ( 4 2 % ) ;对RFP敏感 2个 ( 8 3 % )、低耐 2个( 8 3 % )、高耐 2 0个 ( 83 4% ) ;对SM敏感 1个 ( 4 2 % )、低耐 0个 ( 0 % )、高耐 2 3个 ( 95 8% ) ;对EMB全部敏感。结论　耐多药肺结核病人的痰菌对多种抗结核药物均存在耐药不均一性 ,敏感菌与耐药菌、低耐菌与高耐菌混合存在 ,敏感菌为极少数 ,耐药菌占绝大多数     

2001 至 2005年澳门地区耐药结核病的流行趋势分析

目的分析中国澳门地区2001至2005年结核病的耐药情况。方法选取近5年澳门地区新发结核病患者及复治结核病患者结核分枝杆菌分离株进行4种抗结核药物（异烟肼、利福平、链霉素、乙胺丁醇）的耐药性测定。结果1460株结核分枝杆菌的总耐药率为16．2％（236株），其中初始和获得性耐药率分别为15．0（203／1357）和32．0（33／103）；耐多药率为3．2％（47／1460），其中初始和获得性耐多药率分别为2．3％（31／1357）和15．5％（16／103）；4种抗结核药物的耐药率由高到低依次为异烟肼（11．5％）、链霉素（9．5％）、利福平（3．6％）、乙胺丁醇（2．5％）；耐1种、2种、3种和4种药物的初始耐药率分别为9．9％、2．9％、1．0％和1．2％，获得性耐药率分别为12．6％、3．9％、8．7％和6．8％。近5年新发和复治患者的耐药率没有上升趋势（χ2值分别为0．27和0．03，P均〉0．05）；不同性别和年龄组间初始耐药率的差异无统计学意义（χ2=5．7，P〉0．05）。结论本次流行病学调查结果与1996至1999年澳门地区结核病流行病学调查资料比较，获得性耐药率和获得性耐多药率显著下降，差异有统计学意义（χ2值分别为6．04和7．47，P均〈0．05），但初始耐药率和获得性耐药率高于2004年第3次全球多国耐药监察结果，仍处于高耐药水平，尤其是耐多药率较高的问题，应引起重视。     

重庆市六区(县)耐多药肺结核患者发现治疗现状分析

目的通过分析重庆市6个区(县)的耐多药肺结核患者发现和治疗情况,为探索重庆市的耐药结核病防治模式提供科学依据。方法对三峡库区6个区（县）收集的1189 例涂阳肺结核患者进行传统药敏试验,其中1015例新涂阳肺结核患者,174例耐多药肺结核高危人群;根据耐多药肺结核患者发现和治疗数据,分析不同类型肺结核患者中的耐多药肺结核检出率、菌株运输情况及确诊耐多药肺结核患者未纳入治疗的原因。结果1189 例涂阳肺结核患者中,84 例(7.1%) 确诊为耐多药肺结核。不同性别耐多药检出率比较,男性为6.9%（61/883）、女性为7.5%（23/306）,不同性别间差异无统计学意义（χ²=0.07,P＞0.05）;不同年龄组间耐多药检出率比较,≤20岁、>20～岁、41～岁、61～80岁分别为6.9%（7/102）、8.7%（25/286）、7.8%（39/499）、4.3%（13/302）,不同年龄组间差异无统计学意义（χ²=2.15,P＞0.05）;从患者分类来看,新涂阳肺结核患者的耐多药检出率为3.6%（37/1015）,高危人群检出率为27.0%（47/174）,差异有统计学意义（χ²=123.5,P＜0.01）。耐多药可疑患者留痰至开展药敏试验的总体时间间隔平均为90.9d (66.0～118.9d)。84例确诊耐多药肺结核患者中,22例纳入治疗,纳入治疗率为26.2%（22/84）;62例未纳入治疗,经济困难为未纳入治疗的第一位原因,其患者占41.9%（26/62）。结论重庆市耐多药肺结核发现的筛查对象应为高危人群,应就近设立定点医院耐多药肺结核规范化诊疗管理点,并落实医保政策,解决患者的诊疗费用,以保障患者进行规范化治疗。     

两种间歇短程化疗方案对初治涂阳肺结核近远期疗效观察

本文报道杭州市１９８５～１９８９年市区２２９例初治涂阳肺结核病人，在不住院全程监督或全程管理下，采用２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｈ３Ｒ３（ＤＬ１）和２ＳＨＲＺ／４Ｈ２Ｒ２（ＤＬ１）两种间歇短程化疗（短化）方案治疗。疗程结束痰菌阴转率分别为９７．７％及９９．０％，３年随访复发率为２．４％及３．０％。两方案疗效差异无显著性。认为①６个月间歇短化服药７８～９４次，节省了费用，减少了管理次数值得推广。②原发ＲＦＰ耐药者疗效差，宜改变方案。③全程管理化疗如认真按规范实施，可取得与全程监督管理相似的效果。     

Drug-resistant tuberculosis and HIV in Ukraine: a threatening convergence of two epidemics?

OBJECTIVE: To investigate anti-tuberculosis (TB) drug resistance rates in Donetsk Oblast, Ukraine, and to explore the association between the epidemics of human immunodeficiency virus (HIV) and multidrug-resistant TB (MDR-TB). METHODS: All consecutive newly diagnosed and previously treated patients with sputum smear-positive TB presenting to all TB units in Donetsk Oblast over 12 months were invited to take part in the study. A total of 1293 and 203 patients with TB were tested for HIV and MDR-TB in the civilian and penitentiary sectors, respectively. RESULTS: Of those enrolled for the study, 307 were HIV-positive, 379 had MDR-TB, and 97 had MDR-TB and HIV co-infection. MDR-TB rates in the civilian sector were respectively 15.5% (95%CI 13.1-17.8) and 41.5% (95%CI 36.4-46.5) in newly diagnosed and previously treated TB patients. Among prisoners, MDR-TB rates were 21.8% (95%CI 12.4-31.2) in new cases and 52.8% (95%CI 43.9-61.7) in previously treated TB cases. HIV status was significantly associated with MDR-TB (OR 1.7, 95%CI 1.3-2.3). CONCLUSIONS: High MDR-TB rates and a positive association between MDR-TB and HIV epidemics were found in Donetsk Oblast. Urgent measures to improve HIV prevention, control of drug-resistant TB and collaboration between HIV and TB control activities need to be implemented without further delay.     

Tuberculosis control in the Caucasus: successes and constraints in DOTS implementation.

SETTING: The pilot projects for tuberculosis (TB) control, supported by the World Health Organization (WHO) and based on the WHO recommended control strategy, directly-observed treatment, short-course (DOTS) in the Caucasian countries (Armenia, Azerbaijan, Georgia). OBJECTIVE: To evaluate the results 2 years after the implementation of the pilot projects. METHODS: Analysis of data on case detection, sputum conversion and treatment outcome reported quarterly to the WHO from the Ministries of Health in each country. RESULTS: Since the establishment of the project, 1330, 764 and 4866 new cases and relapses, respectively, of TB have been detected in the pilot areas of Armenia, Azerbaijan and Georgia. In Armenia and Azerbaijan, respectively 46% and 57% of all cases were smear positive, whilst in Georgia, the corresponding figure was only 12%. After 3 months' treatment, 93% of new smear-positive patients had become smear-negative. The sputum conversion rate for relapses and other retreatment cases (failure, treatment interrupted) was 85%. In Armenia, 78.1% of new smear-positive patients were treated successfully (cured or completed treatment). The corresponding percentages for Azerbaijan and Georgia were 87.9% and 59.6%. Treatment success rates among retreatment cases was generally low, at respectively 46%, 64%, and 35%, in Armenia, Azerbaijan, and Georgia. CONCLUSION: The results of the implementation of the WHO TB control pilot projects in Armenia, Azerbaijan and Georgia suggest that the DOTS strategy is feasible in emergency situations in general, and in the Caucasus in particular.     

武汉市首次复治涂阳肺结核治疗结局及影响因素分析

目的 探讨武汉市首次复治涂阳肺结核患者疗效影响因素,以便有针对性地采取措施提高复治肺结核疗效。 方法 采用整群抽样法,抽取武汉市2011年7月至2012年3月登记的全部首次复治涂阳患者（共232例）作为研究对象。面访式问卷调查,随访治疗结局。232份调查问卷中,219份合格,合格率94.4%。进行χ²检验及多因素逐步logistic回归分析疗效影响因素。 结果219例首次复治涂阳肺结核患者中,治疗成功156例,成功率为71.2%。伴发糖尿病患者治疗成功率为51.2%（21/41）,不伴发糖尿病患者治疗成功率为75.8%(135/178),差异有统计学意义(χ²=9.860, P=0.002);耐药者治疗成功率为55.0%(33/60),不耐药者治疗成功率为73.7%(87/118),差异有统计学意义(χ²=6.351, P=0.012);耐多药者治疗成功率为26.1%(6/23),非耐多药患者治疗成功率为73.5%(114/155),差异有统计学意义(χ²=20.538, P=0.000)。多因素逐步logistic回归分析显示,耐多药(OR=10.758, 95%CI=3.481～33.247)是治疗不成功的危险因素,差异有统计学意义(P<0.01);伴发糖尿病(OR=2.838, 95%CI=1.187～6.788)及未采用医生督导式管理(OR=1.678, 95%CI=1.087～2.588)是治疗不成功的危险因素,差异有统计学意义（P值均<0.05)。 结论 武汉市首次复治涂阳肺结核患者治疗成功率不高,耐多药、伴发糖尿病及未采用医生督导模式管理是影响复治涂阳肺结核疗效的主要因素。     

含力克肺疾方案治疗耐多药结核病的疗效及评价

目的　观察和评价含力克肺疾方案在耐多药结核病(MDR-TB)治疗中的疗效。方法 采用随机配对分组法将62例MDR-TB患者分为治疗组(M组,31例)和对照组(C组,31例)。化疗方案:M组以力克肺疾为主,另依据药敏试验选用3种以上敏感药或既往未用过的新药。C组不用力克肺疾,其它药物同M组。结果 治疗9个月后,M组涂阳阴转率61%,培阳阴转率65%;C组涂阳阴转率29%,培阳阴转率32%。痰菌阴转率M组显著高于C组(P<0.05)。M组病灶吸收及空洞关闭、缩小速度均显著高于C组(P<0.05)。2年复查,M组和C组痰菌复阳率分别为5%和20%。结论 含力克肺疾方案治疗MDR-TB,有助于痰菌阴转和病灶吸收好转,疗程结束后复发率低,疗效较为满意,值得临床上推广应用。     

Resistance to anti-tuberculosis drugs among smear-positive cases in Thai prisons 2 years after the implementation of the DOTS strategy.

SETTING: Three prisons in Bangkok and vicinity, Thailand. OBJECTIVE: To examine the prevalence of drug-resistant tuberculosis among smear-positive cases in Thai prisons 2 years after the implementation of the DOTS strategy, and to identify factors associated with resistance to anti-tuberculosis drugs. METHODS: In a cross-sectional study, 154 consecutive tuberculosis patients with at least one positive sputum smear and at least one positive sputum culture registered between 1 May and 31 October 2000 were enrolled. Drug susceptibility testing was performed by the Ministry of Public Health Tuberculosis Division. Patient characteristics were obtained by face-to-face interview. RESULTS: Resistance to at least one drug was found in 50.6% of the subjects, including multidrug-resistant tuberculosis (MDR-TB) in 19.5%. The proportion of resistance to any anti-tuberculosis drug in prisons A, B and C was respectively 52.7%, 37.8% and 61.5%. The only factor significantly associated with resistance to at least one drug (P = 0.011) and MDR-TB (P < 0.001) was a history of previous tuberculosis treatment. CONCLUSION: After 2 years of the DOTS strategy, resistance to anti-tuberculosis drugs, an indicator of the quality of tuberculosis treatment, was found to be high. The DOTS strategy currently used in Thai prisons should be reviewed, in order to reduce and prevent drug-resistant tuberculosis.     

复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析

目的 分析耐异烟肼、耐利福平和敏感的复治肺结核患者的治疗结局,探讨耐异烟肼患者的预后。方法 采取回顾性调查的方法,选择2009年7月至2019年7月首都医科大学附属北京胸科医院联合国内20余家结核病防治机构共同合作纳入的资料完整并有治疗转归结果的922例复治菌阳肺结核患者,排除219例耐多药及广泛耐药肺结核患者,排除非利福平和非异烟肼耐药的100例患者,共入选复治菌阳肺结核患者603例。复治肺结核敏感患者的治疗方案采用复治标准化方案,耐异烟肼或耐利福平治疗方案采用个体化方案,对其中药物敏感的485例患者(简称“敏感组”)、耐异烟肼(包含异烟肼单耐药和多耐药)的73例患者(简称“耐异烟肼组”)和耐利福平(包含利福平单耐药和多耐药)的45例患者(简称“耐利福平组”)的治疗转归进行对比分析。结果 在治疗2个月末时,耐异烟肼组痰涂片阴转率(63.6%,42/66)和痰培养阴转率(63.6%,35/55)均分别低于耐利福平组[84.6%(33/39)和70.6%(24/34)]和敏感组[84.2%(388/461)和80.0%(343/429)],差异均有统计学意义(χ²=16.567,P<0.001;χ²=8.500,P=0.014);在治疗6个月末时,耐异烟肼组痰涂片阴转率(79.7%,47/59)和痰培养阴转率(76.5%,39/51)均分别低于耐利福平组[89.2%(33/37)和93.5%(29/31)]和敏感组[91.5%(398/435)和90.8%(367/404)],差异均有统计学意义(χ²=8.127,P=0.017;χ²=10.533,P=0.005)。耐异烟肼组治愈率(53.4%,39/73)低于耐利福平组(60.0%,27/45)和敏感组(69.5%,337/485),差异有统计学意义(χ²=8.407,P=0.015);耐异烟肼组治疗成功率(64.4%,47/73)低于耐利福平组(75.6%,34/45)和敏感组(82.1%,398/485),差异有统计学意义(χ²=12.587,P=0.002)。结论 复治肺结核患者中,耐异烟肼患者痰菌阴转率和治疗成功率均低于耐利福平患者和敏感患者;应重视每一种药品的耐药情况,特别是临床应用时间较长的药品。     

Emergence of multidrug-resistant tuberculosis in a community-based directly observed treatment programme in rural South Africa.

OBJECTIVE: Although little studied in developing countries, multidrug-resistant tuberculosis (MDR-TB) is considered a major threat. We report the molecular epidemiology, clinical features and outcome of an emerging MDR-TB epidemic. METHODS: In 1996 all tuberculosis suspects in the rural Hlabisa district, South Africa, had sputum cultured, and drug susceptibility patterns of mycobacterial isolates were determined. Isolates with MDR-TB (resistant to both isoniazid and rifampicin) were DNA fingerprinted by restriction fragment length polymorphism (RFLP) using IS6110 and polymorphic guanine-cytosine-rich sequence-based (PGRS) probes. Patients with MDR-TB were traced to determine outcome. Data were compared with results from a survey of drug susceptibility done in 1994. RESULTS: The rate of MDR-TB among smear-positive patients increased six-fold from 0.36% (1/275) in 1994 to 2.3% (13/561) in 1996 (P = 0.04). A further eight smear-negative cases were identified in 1996 from culture, six of whom had not been diagnosed with tuberculosis. MDR disease was clinically suspected in only five of the 21 cases (24%). Prevalence of primary and acquired MDR-TB was 1.8% and 4.1%, respectively. Twelve MDR-TB cases (67%) were in five RFLP-defined clusters. Among 20 traced patients, 10 (50%) had died, five had active disease (25%) and five (25%) were apparently cured. CONCLUSIONS: The rate of MDR-TB has risen rapidly in Hlabisa, apparently due to both reactivation disease and recent transmission. Many patients were not diagnosed with tuberculosis and many were not suspected of drug-resistant disease, and outcome was poor.     

Efficacy and safety of kanamycin, ethionamide, PAS and cycloserine in multidrug-resistant pulmonary tuberculosis patients

BACKGROUND: We carried out this study to determine the efficacy and safety of a regimen containing kanamycin, ethionamide, isoniazid, para-aminosalicylic acid (PAS) and cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB). METHODS: A prospective, uncontrolled study of 39 pulmonary tuberculosis patients, who had received adequate first-line antituberculosis treatment including supervised category II retreatment regimen, and were still sputum smear positive for acid-fast bacilli (AFB) in whom sputum culture revealed isolates of M. tuberculosis resistant to rifampicin and isoniazid with and without resistance to other antituberculosis drugs. They received kanamycin (initial 4-6 months), ethionamide, isoniazid, PAS and cycloserine for a minimum period of two years. RESULTS: Out of 39 patients, 29 (74.3%) achieved sputum conversion within six months and remained so at the end of two years. Two (5.1%) patients died, six (20.6%) patients were lost to follow up, and two (5.1%) patients remained sputum smear-positive for AFB through out the period of study. Twenty-nine patients, declared cured, were followed for an average period of 16 months (3-48 months), during which two (6.9%) patients relapsed, four (13.8%) patients were lost to follow-up and remaining 23 remained sputum smear-negative. Eight (21.1%) patients developed major side effects which required stoppage/change of drugs. CONCLUSION: In MDR-TB patients, regimen consisting of ethionamide, isoniazid, PAS and cycloserine and kanamycin appears to be effective and safe.