Drug-resistant tuberculosis in Ethiopia: problem scenarios and recommendation

Tuberculosis (TB) is a major public health problem in Ethiopia. This review is prepared to indicate possible future challenges related to tuberculosis control and it includes previous reports of drug-resistant surveys in Ethiopia. Drug-resistant TB, both initial and acquired, was reported from different regions of the country. In studies from 1984 to 2001, the initial resistance to isoniazid ranges from 2% to 21% and initial resistance to streptomycin ranges from 2 to 20%. Multidrug-resistance (MDR) TB defined as resistance to at least isoniazid and rifampicin was also reported in about 1.2% of new cases and 12% of re-treatment cases. In all studies which included ethambutol susceptibility test, ethambutol resistance is either nil or very low (below 0.5%). All MDR isolates were susceptible to ethambutol. Treatment and re-treatment regimens recommended by the National TB/Leprosy Control Program could be effective on all cases other than those with MDR-TB. MDR-TB is difficult to cure. Therefore, special emphasis should be given to control the spread of MDR-TB. Lack of control efforts may lead to the increased resistance to both first- and second-line drugs. A well supported and controlled special treatment unit, which uses both first-line and second-line drugs is required for a proper management of these cases and for effective control of the spread of MDR-TB. A uniform susceptibility to ethambutol can be taken as an advantage to develop standard low-cost re-treatment regimen for MDR-TB patients.