WHAT
This cross-sectional descriptive study examined resistance patterns to second-line anti-tuberculosis drugs among drug-resistant tuberculosis (DR-TB) patients treated at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. A total of 134 patient records were retrieved, but after excluding duplicate entries and incomplete data, 82 patients were included in the final analysis. The median age of participants was 42 years (range 27–51 years), and most patients were female (53.7%). Over half of the patients (52.4%) were classified as new or primary MDR-TB cases, followed by relapse cases (29.3%).
Drug susceptibility testing showed that resistance to high-dose isoniazid was the most common, affecting 43.9% of patients. Resistance to fluoroquinolones was also observed, with 14.6% showing resistance to low-dose moxifloxacin and an equal proportion (14.6%) resistant to low-dose levofloxacin. Among patients resistant to low-dose moxifloxacin, a subset also demonstrated cross-resistance to other fluoroquinolones, indicating potential limitations in second-line treatment options.
Testing using the Mycobacteria Growth Indicator Tube (MGIT) further confirmed resistance patterns, showing high-dose isoniazid resistance as the most frequent, followed by low-dose levofloxacin resistance (9.8%). These findings highlight that resistance extended beyond first-line therapy and affected important second-line drugs used in MDR-TB management.
Most patients were of productive working age, suggesting a substantial potential socioeconomic burden of MDR-TB. Additionally, the high proportion of primary MDR-TB cases indicates ongoing transmission of drug-resistant strains rather than resistance developing solely from prior treatment failure.
Overall, the study identified considerable resistance to both high-dose isoniazid and fluoroquinolones among MDR-TB patients. These findings emphasize the importance of drug susceptibility testing to guide individualized treatment regimens and prevent treatment failure.
HOW
This study used a descriptive cross-sectional design based on secondary data obtained from the Tuberculosis Information System (SITB) at the MDR clinic of Dr. Hasan Sadikin General Hospital in Bandung, West Java, Indonesia. The study period covered patients registered between December 2021 and June 2022. Total sampling was applied to include all eligible patients during the study period.
Inclusion criteria were patients aged 18 years or older diagnosed with drug-resistant tuberculosis and treated at the MDR clinic. Patients with incomplete records or missing data were excluded. From 134 retrieved records, 7 duplicate entries and 45 incomplete records were excluded, resulting in 82 patients included in the final analysis.
Collected variables included demographic characteristics (age and gender), history of previous anti-tuberculosis treatment, and second-line drug susceptibility test results. Previous treatment history included categories such as new cases, relapse, treatment failure, loss to follow-up, TB-HIV co-infection, and exposure to MDR-TB contacts.
Drug resistance patterns were assessed using two laboratory methods: Line Probe Assay (LPA) and Mycobacteria Growth Indicator Tube (MGIT). These tests evaluated resistance to second-line anti-tuberculosis drugs including moxifloxacin (low-dose and high-dose), levofloxacin, and high-dose isoniazid.
Source: Suwandi, S.N., Kulsum, I.D. and Andriyoko, B., 2024. Second-Line Anti-Tuberculosis Drugs Susceptibility Pattern in Multidrug-resistant Tuberculosis Patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Althea Medical Journal, 11(2), pp.100-105.
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