Multidrug-resistant tuberculosis at Srinagarind Hospital,Khon Kaen,Thailand

Pulmonary tuberculosis is a very common infectious disease in Thailand. Multidrug-resistant tuberculosis (MDR-TB) is the most serious form of the disease. Failure to control resistant tuberculosis is associated with its resurgence. The objective of this study was to analyze the drug susceptibility pattern of M. tuberculosis and to study the clinical characteristics and outcome of patients diagnosed with MDR-TB at Srinagarind Hospital. Between January 1995 and December 2000, 899 isolates of M. tuberculosis were recovered. Rifampicin (RIF) resistance was the most common finding (8.2%). Twenty-two patients (2.4%) were infected with MDR-TB. Other susceptibility results showed resistance to isoniazid (INH) (4.2%), ethambutol (EMB) (4.3%), streptomycin (SM) (3.7%), kanamycin (Kana) (3.0%), and ofloxacin (Oflox) (2.3%). Twenty MDR-TB patients were retrospectively reviewed. The mean age was 37 years (range: 17 to 64). The male to female ratio was 3:1. The mean duration of symptoms before treatment was 3.8 months (range: 3 days to 2 years). The commonest comorbidity was HIV-infection (7 patients). Eleven patients (55%) had a past history of treatment with anti-TB drugs. In addition to INH and RIF resistance, many organism also resisted EMB (35%), SM (30%), Oflox (30%), and Kana (10%). Only five patients (25%) responded to medical treatment. Seven patients (35%) died, and the other eight were unavailable for an evaluation of clinical outcome. Although the prevalence of MDR-TB was not high in Srinagarind Hospital, the treatment was costly and the outcomes were poor. Preventing new cases of MDR-TB by using effective treatment strategies for patients with drug-sensitive TB is a priority.