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Global Trends in Resistance to Antituberculosis Drugs.

Background: Data on global trends in resistance to antituberculosis drugs are lacking.

Methods: We expanded the survey conducted by the World Health Organization and the International Union against Tuberculosis and Lung Disease to assess trends in resistance to antituberculosis dugs in countries on six continents. We obtained data using standard protocols from ongoing surveillance or from surveys of representative samples of all patients with tuberculosis. The standard sampling techniques distinguished between new and previously treated patients, and laboratory performance was checked by means of an international program of quality assurance.

Results: Between 1996 and 1999, patients in 58 geographic sites were surveyed; 28 sites provided data for at least two years. For patients with newly diagnosed tuberculosis, the frequency of resistance to at least one antituberculosis drug ranged from 1.7% in Uruguay to 36.9% in Estonia (median, 10.7%). The prevalence increased in Estonia, from 28.2% in 1994 to 36.9% in 1998 (P=0.01), and in Denmark, from 9.9% in 1995 to 13.1% in 1998 (P=0.04). The median prevalence of multidrug resistance among new cases of tuberculosis was only 1.0%, but the prevalence was much higher in Estonia (14.1%), Henan Province in China (10.8%), Latvia (9.0%), the Russian oblasts of Ivanovo (9.0%) and Tomsk (6.5%), Iran (5.0%), and Zhejiang Province in China (4.5%). There were significant decreases in multidrug resistance in France and the United States. In Estonia, the prevalence in all cases increased from 11.7% in 1994 to 18.1% in 1998 (P[greater than]0.00l).

Conclusions: Multidrug-resistant tuberculosis continues to be a serious problem, particularly among some countries of eastern Europe. Our survey also identified areas with a high prevalence of multidrug-resistant tuberculosis in such countries as China and Iran.

Espinal M, et al. N Engl J Med April 26, 2001; 344(17):1294-303.

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Publication:Original Internist
Article Type:Brief Article
Geographic Code:00WOR
Date:Jun 1, 2001
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