High initial drug resistance in pulmonary tuberculosis in Ghana

Between July 1985 and March 1987, initial sensitivity to anti-tuberculosis drugs was studied in patients presenting at the Chest Clinic of Agogo Hospital in the forest area of Ghana. Culture and sensitivity test results were obtained in 99 out of 123 consecutive patients with pulmonary tuberculosis who claim not to have received previous treatment. Isoniazid resistance was alarmingly high in the isolates of M. tuberculosis: 21 out of 57 (37%), and thiacetazone resistance was very high in the M. africanum isolates: 20 out of 42 (47%). Overall resistance was high: 27% to isoniazid, 23% to streptomycin, 29% to thiacetazone, 16% to both streptomycin and isoniazid, and 5% to all of these three drugs. Only 45% of the isolates were sensitive to all three drugs. Primary drug resistance to rifampicin, pyrazinamide or ethambutol was not observed. Besides the standard treatment of isoniazid, streptomycin and thiacetazone, rifampicin and pyrazinamide were usually added for the first two months of treatment. Of 13 patients who received standard treatment only, 4 of the 5 patients with resistant organisms who could be followed up failed to respond, whereas there were no failures to respond in the 5 corresponding patients with initially sensitive organisms; 3 patients could not be assessed because they defaulted.