Tuberculosis drug resistance and treatment outcomes under DOTS settings in large cities in the Philippines

Two large cities in the Philippines.

To describe the problems of drug-resistant tuberculosis (TB) in an urban setting, with special emphasis on their potential impact on the treatment services provided by the National TB Control Programme.

Cross-sectional survey and cohort analysis of treatment outcomes.

All patients with positive sputum smear examination results in Cebu and Mandaue cities during the survey period were included. The survey procedures of the World Health Organization and the International Union Against Tuberculosis and Lung Disease were strictly applied. Treatment outcome data were also collected.

Of 306 cases enrolled, 255 were new cases, 28 were previously treated and for 23 treatment history was unknown. Of the new cases, 72.2% were pan-susceptible to all four first-line anti-tuberculosis drugs. Resistance in new cases was 16.9% to isoniazid (INH), 4.7% to rifampicin (RMP), 3.1% to ethambutol, 18.0% to streptomycin, and 3.9% to at least both INH and RMP (multidrug-resistant [MDR]). Over 90% of the new cases, either pan-susceptible or mono-resistant, were successfully treated with the standard regimen, but four of nine MDR new cases could not be cured.

The drug resistance level was high in this population, but treatment outcome using the standard treatment regimen was not seriously affected unless the patients were MDR.