Multidrug-resistant tuberculosis in Rawalpindi, Pakistan.

INTRODUCTION Multidrug-resistant (MDR) tuberculosis (TB) strains are resistant to isoniazid and rifampicin. Clinical characteristics, drug susceptibility patterns, and outcomes of MDR-TB patients treated at Holy Family Hospital, Rawalpindi, Pakistan, were studied from January 2007 to April 2010. METHODOLOGY Thirty diagnosed patients (60% male and 40% female) of MDR pulmonary TB were included. Each patient was treated according to WHO guidelines and followed for two years. Clinical characteristics (age, gender, literate or illiterate educational status, employment status, and income), drug susceptibility testing (DST) reports, and outcome (cured, treatment failure, default, and died) of each patient was noted. RESULTS Mean patient age was 36.2 ± 15.4 years. In total, 60% patients were illiterate, 60% employed, 60% had income < Rs 5000 (42 Euro per month), 73.3% lived in an overcrowded residence, 60% were smokers, and 83.3% had taken anti-tuberculosis therapy previously. DST of MDR-TB strains for ethambutol, pyrazinamide, and streptomycin showed high resistance ( > 60%). Except for ofloxacin and ciprofloxacin, < 20% resistance was noted in second-line anti-tuberculosis agents. Overall, 10% of patients were cured, 40% died, 20% had treatment failure, and 30% patients defaulted. CONCLUSION Pulmonary MDR-TB in Rawalpindi, Pakistan, is common in young males, poverty related circumstances, and has poor outcome. DST shows high resistance to first- line anti-tuberculosis agents and quinolones.