Global Surveillance for Antituberculosis-Drug Resistance, 1994-1997

doi:10.1056/NEJM199806043382301

A correction has been published: N Engl J Med 1998;339(2):139.

Volume 338:1641-1649		June 4, 1998		Number 23

Global Surveillance for Antituberculosis-Drug Resistance, 1994–1997

Ariel Pablos-Méndez, M.D., M.P.H., Mario C. Raviglione, M.D., Adalbert Laszlo, Ph.D., Nancy Binkin, M.D., M.P.H., Hans L. Rieder, M.D., M.P.H., Flavia Bustreo, M.D., M.P.H., David L. Cohn, M.D., Catherina S.B. Lambregts-van Weezenbeek, M.D., Ph.D., Sang Jae Kim, Sc.D., Pierre Chaulet, M.D., Paul Nunn, M.D., for The World Health Organization–International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance

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by Snider, D. E.

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ABSTRACT

Background Drug-resistant tuberculosis threatens efforts tocontrol the disease. This report describes the prevalence ofresistance to four first-line drugs in 35 countries participatingin the World Health Organization–International Union againstTuberculosis and Lung Disease Global Project on Anti-TuberculosisDrug Resistance Surveillance between 1994 and 1997.

Methods The data are from cross-sectional surveys and surveillancereports. Participating countries followed guidelines to ensurethe use of representative samples, accurate histories of treatment,standardized laboratory methods, and common definitions. A networkof reference laboratories provided quality assurance. The mediannumber of patients studied in each country or region was 555(range, 59 to 14,344).

Results Among patients with no prior treatment, a median of9.9 percent of Mycobacterium tuberculosis strains were resistantto at least one drug (range, 2 to 41 percent); resistance toisoniazid (7.3 percent) or streptomycin (6.5 percent) was morecommon than resistance to rifampin (1.8 percent) or ethambutol(1.0 percent). The prevalence of primary multidrug resistancewas 1.4 percent (range, 0 to 14.4 percent). Among patients withhistories of treatment for one month or less, the prevalenceof resistance to any of the four drugs was 36.0 percent (range,5.3 to 100 percent), and the prevalence of multidrug resistancewas 13 percent (range, 0 to 54 percent). The overall prevalenceswere 12.6 percent for single-drug resistance (range, 2.3 to42.4 percent) and 2.2 percent for multidrug resistance (range,0 to 22.1 percent). Particularly high prevalences of multidrugresistance were found in the former Soviet Union, Asia, theDominican Republic, and Argentina.

Conclusions Resistance to antituberculosis drugs was found inall 35 countries and regions surveyed, suggesting that it isa global problem.

Source Information

From the Global Tuberculosis Program, World Health Organization, Geneva (A.P.-M., M.C.R., F.B., P.C., P.N.); the Divisions of General Medicine and Epidemiology, Columbia University, New York (A.P.-M.); the International Union against Tuberculosis and Lung Disease, Paris (A.L., H.L.R.); the Laboratory Center for Disease Control, Ottawa, Ont., Canada (A.L.); the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta (N.B.); the Denver Public Health Department and the University of Colorado Health Sciences Center, Denver (D.L.C.); the Royal Netherlands Tuberculosis Association, The Hague (C.S.B.L.-W.); and the Korean Institute of Tuberculosis, Seoul (S.J.K.).

Address reprint requests to Dr. Pablos-Méndez at the Division of General Medicine, Columbia College of Physicians and Surgeons, 622 W. 168th St., PH-9E-105, New York, NY 10032.

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Antituberculosis-Drug Resistance
Chan-Tack K. M., Diaz J. F., Geerligs W. A., van Altena R., van der Werf T. S., Pablos-Méndez A., Raviglione M. C., Nunn P.
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N Engl J Med 1998; 339:1079-1080, Oct 8, 1998. Correspondence

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