Sharma Amit Kumar, Gupta Neeraj, Kala Dilip Kumar, Patni Tarun, Dixit Ramakant, Verma Satyadeep, Chandran Arjun
Resident, Department of Respiratory Medicine, J.L.N. Medical College, Ajmer, India.
Professor and Head, Department of Respiratory Medicine, J.L.N. Medical College, Ajmer, India.
Indian J Tuberc. 2018 Jul;65(3):233-236. doi: 10.1016/j.ijtb.2018.02.005. Epub 2018 Feb 21.
To determine the prevalence and pattern of resistance to second line drugs among multi drug resistant (MDR) tuberculosis patients being treated on category IV regimen.
This study was conducted at Department of Respiratory Medicine, J.L.N. Medical College, Ajmer in collaboration with IRL, STDC, Ajmer. Second line anti tubercular drug sensitivity for 398 multi drug resistant tuberculosis patients (between June-2015 and June-2016) was done to find out prevalence and pattern of resistance to second line drugs. Second line drug sensitivity was performed at accredited laboratory, Microbiology department, S.M.S. Medical College, Jaipur.
Among these 398 patients, 136 (34.17%) were resistant to fluoroquinolones (Ofloxacin) (Pre XDR); 18 (4.52%) were resistant to one of the aminoglycosides (Inj. Kanamycin, Capreomycin, Amikacin) (Pre XDR); while 22 (5.53%) patients were resistant to fluoroquinolones as well as aminoglycosides (XDR). 148 (37.18%) patients were found sensitive to both the drugs. Samples of 41 (10.3%) patients were contaminated and no growth was seen in 33 (8.29%) patients.
Nearly half of the multi drug resistant (MDR) tuberculosis patients (44.22%) being treated on category IV regimen also have resistance to either fluoroquinolones or aminoglycosides or both i.e. Pre XDR or XDR. This may result in poor outcome of category IV regimen under RNTCP. There is a strong need for provision of culture sensitivity for all first line drugs and at least two second line drugs viz. Fluoroquinolones and aminoglycosides for all the patients registered as smear positive under RNTCP. There is also a need for development of rapid culture technique for sensitivity to second line drugs.
确定接受IV类方案治疗的耐多药（MDR）结核病患者中对二线药物的耐药率及耐药模式。
本研究由阿杰梅尔J.L.N.医学院呼吸内科与阿杰梅尔IRL、STDC合作开展。对398例耐多药结核病患者（2015年6月至2016年6月期间）进行二线抗结核药物敏感性检测，以查明对二线药物的耐药率及耐药模式。二线药物敏感性检测在斋浦尔S.M.S.医学院微生物学系认可实验室进行。
在这398例患者中，136例（34.17%）对氟喹诺酮类（氧氟沙星）耐药（预广泛耐药）；18例（4.52%）对一种氨基糖苷类药物（卡那霉素注射液、卷曲霉素、阿米卡星）耐药（预广泛耐药）；而22例（5.53%）患者对氟喹诺酮类和氨基糖苷类均耐药（广泛耐药）。148例（37.18%）患者对两种药物均敏感。41例（10.3%）患者的样本被污染，33例（8.29%）患者未见细菌生长。
接受IV类方案治疗的耐多药（MDR）结核病患者中，近一半（44.22%）对氟喹诺酮类或氨基糖苷类或两者均耐药，即预广泛耐药或广泛耐药。这可能导致国家结核病防治规划下IV类方案的治疗效果不佳。迫切需要为所有一线药物以及至少两种二线药物（即氟喹诺酮类和氨基糖苷类）对所有在国家结核病防治规划下登记为涂片阳性的患者进行培养药敏检测。还需要开发针对二线药物敏感性的快速培养技术。
