Author(s): Githui WA, Kwamanga D, Chakaya JM, Karimi FG, Waiyaki PG
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Abstract Our experience at the Respiratory Diseases Research Unit (RDRU), over the last 10 years (1981-1990) on the initial drug resistance pattern, focusing on three drugs viz: isoniazid (H), streptomycin (S) and rifampicin (R) is presented. Records on all isolates of M. tuberculosis from one specimen of every newly diagnosed patient recruited countrywide between 1981-1990 were reviewed. We analyzed records of 6,514 isolates and found that total resistance to the three drugs had increased from 8.9\% to 14.4\%. Resistance to H alone increased from 6.8\% to 10.2\% while that of S alone from 0.8\% to 1.8\%. Resistance to R was between 0.1\% and 0.3\%. Generally, the increase in the resistance trend to both H and S was statistically significant (p = < 0.05 and 0.03, respectively). Although in our analysis we did not address the possible impact of HIV infection, we hope that these findings form a basis for evaluation of this and other possible factors on the emergence of anti-TB drug resistance in future studies. PIP: A retrospective review of medical records of 6514 Mycobacterium tuberculosis isolates of newly diagnosed patients at the Respiratory Diseases Research Unit of the Kenya Medical Research Institute between 1981 and 1990 aimed to determine the initial drug-resistance pattern for isoniazid, streptomycin, and rifampicin. Overall resistance increased from 8.9 to 14.4\% (p 0.001). The increase in the resistance trend to isoniazid and to streptomycin were statistically significant (6.8-10.2; p 0.05 and 0.8-1.8; p = 0.03, respectively) as well as the trend among isolates resistant to both isoniazid and streptomycin (1.2.4; p = 0.03). The trend was more pronounced during 1987-1990 than during 1981-1986. There was no trend in the resistance to rifampicin alone (0.1-0.3\%). Just 4 isolates were resistant to both isoniazid and rifampicin. Only 1 was resistant to both streptomycin and rifampicin. None were resistant to all 3 antibiotics. These first-line drugs are used widely in Kenya. These rates of initial resistance to the drugs are lower than those in other developing countries. The lower resistance rate is unlikely to continue, however, due to higher prevalence of HIV infection and the associated increase in tuberculosis incidence. These findings provide researchers a baseline with which to study M. tuberculosis drug resistance and other risk factors as drug resistance increases in Kenya.
This article was published in East Afr Med J
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