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Volume 17, Number 3—March 2011

Dispatch

Increasing Drug Resistance in Extensively Drug-Resistant Tuberculosis, South Africa

N. Sarita ShahComments to Author , Jessica Richardson, Prashini Moodley, Salona Moodley, Palav Babaria, Melissa Ramtahal, Scott K. Heysell, Xuan Li, Anthony P. Moll, Gerald Friedland, A. Willem Sturm, and Neel R. Gandhi
Author affiliations: Author affiliations: Tugela Ferry Care and Research Collaboration, Tugela Ferry, South Africa (N.S. Shah, J. Richardson, P. Babaria, S.K. Heysell, A.P. Moll, G. Friedland, N.R. Gandhi); Albert Einstein College of Medicine, Bronx, New York, USA (N.S. Shah, J. Richardson, X. Li, N.R. Gandhi); Montefiore Medical Center, Bronx (N.S. Shah, J. Richardson, X. Li, N.R. Gandhi); Nelson R. Mandela School of Medicine, Durban, South Africa (P. Moodley, S. Moodley, M. Ramtahal, A.W. Sturm); Yale University, New Haven, Connecticut, USA (P. Babaria, G. Friedland); Philanjalo Care Center, Tugela Ferry (A.P. Moll)

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Table 2

Characteristics of 30 MDR TB and XDR TB patients, South Africa*

Characteristic MDR TB 6- or 7-drug XDR TB 8-drug XDR TB
Total 11 6 13
Female sex 8 (73) 4 (67) 5 (38)
Age, y, median (range)
36 (26–52)
42.5 (36–64)
33.5 (24–51)
Prior TB treatment
First-line drugs† 5 (45) 5 (83) 5 (38)
Second-line drugs‡
0
0
0
TB contact 2 (18) 2 (33) 1 (8)
Enrollment site at HIV clinic 8 (73) 2 (33) 7 (54)
HIV positive 10 (91) 5 (83) 12 (92)
CD4 cell count, cells/mm3, median (range) 155 (25–708) 117.5 (18–426) 183.5 (22–670)
Receiving antiretroviral therapy (among HIV-positive patients) 7 (70) 2 (40) 2 (17)

*Values are no. (%) unless otherwise indicated. MDR TB, multidrug-resistant tuberculosis; XDR TB, extensively drug-resistant TB. 6-drug resistance, resistance to isoniazid, rifampin, ethambutol, ofloxacin, kanamycin, and streptomycin; 7-drug resistance, resistance to isoniazid, rifampin, ethambutol, ofloxacin, kanamycin, streptomycin, and capreomycin; 8-drug resistance, resistance to isoniazid, rifampin, ethambutol, ofloxacin, kanamycin, streptomycin, capreomycin, and ethionamide.
†First-line drugs used for treatment of persons with new TB cases or confirmed drug-susceptible TB include isoniazid, rifampin, ethambutol, and pyrazinamide.
‡Second-line drugs used for treatment of persons with confirmed MDR TB include ofloxacin, kanaymycin, ethionamide, p-aminosalicylic acid, and cycloserine or terizidone.

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