Multi-drug resistant tuberculosis in Northern Pakistan.

OBJECTIVE To determine the resistance pattern of Mycobacterium tuberculosis isolates in Rawalpindi-Islamabad. METHODS The study was carried out at the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi between September 2000 and August 2002. We examined 1359 pulmonary and extra-pulmonary specimens from suspected cases of tuberculosis. The radiometric Bactec 460 TB system was used for culture and antimicrobial susceptibility testing. RESULTS Mycobacterium tuberculosis was isolated from 325 clinical specimens. Antimicrobial susceptibility of the isolates was tested against the four first-line anti-tuberculous drugs (rifampicin, isoniazid, streptomycin and ethambutol). Fifteen percent of the isolates were resistant to a single drug, 28% were multi-drug resistant including 7% which were resistant to all the four drugs. The overall resistance against individual drugs was rifampicin 32%, isoniazid 37%, streptomycin 19% and ethambutol 17%. CONCLUSIONS The increasing level of drug resistance among mycobacterial isolates in our population is most alarming. Strict implementation of control measures is required to combat this unfolding crisis.