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DRUG-RESISTANT TUBERCULOSIS IN THE U.S.

Several outbreaks of multiple-drug-resistant tuberculosis have been reported in the past few years. This analysis of cases reported to the Centers for Disease Control documents the extent of the problem.

In the first three months of 1991, 4051 culture-positive cases of TB were reported. Of 3313 cases that were tested for drug susceptibility, 472 (14 percent) were resistant to at least one drug, and 41 percent of these cases were resistant to more than one drug. Overall, nearly 10 percent of tested cases were resistant to isoniazid, rifampin, or both. Among new TB cases, resistance rates were 8.2 percent for isoniazid, 3.5 percent for rifampin, 2.3 percent for ethambutol, and 5.6 percent for streptomycin. Rates among recurrent cases were 21.5 percent for isoniazid and 9 percent for rifampin.

Thirty-six states reported resistant cases. The resistance rate was 52.4 times higher in New York City than in the rest of the nation and accounted for two thirds of cases.

Comment: It appears that at least 1 in 10 TB cases is caused by a resistant organism. Because up to 95 percent of organisms would be covered by four-drug regimens, this survey strengthens the case for widespread use of four-drug regimens for TB.

— TH Lee

Published in Journal Watch General Medicine March 18, 1994

Citation(s):

Bloch AB et al. Nationwide survey of drug-resistant tuberculosis in the United States. JAMA 1994 Mar 2 271 665-671.

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