Evaluation of Drug Resistance from Sputum Specimens of Suspected Tuberculosis Patients attending a District Hospital, Abuja

Evaluation of Drug Resistance from Sputum Specimens of Suspected Tuberculosis Patients attending a District Hospital, Abuja | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Evaluation of Drug Resistance from Sputum Specimens of Suspected Tuberculosis Patients attending a District Hospital, Abuja Abbas Abel Anzaku This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.9513/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This study evaluated the prevalence of drug resistant tuberculosis infection among suspected tuberculosis patients attending Asokoro District Hospital (ADH), Abuja, Nigeria. Methods: A total of 301 AFB+/- sputum specimens from suspected TB patients were collected for the study following study approval from Asokoro District Hospital Ethic Committee. Eighty-nine (89) identified Mycobacterium tuberculosis complex were isolated after morphological and biochemical testing. Sputum specimens collected from the patients were processed, cultured on Lowenstein-Jensen (LJ) media and subjected to in-vitro antimicrobial susceptibility testing. The eighty-nine (89) identified M. tuberculosis complex isolates were challenged with Rifampicin (RIF), Isoniazid (INH), Ethambutol (EMB) and Streptomycin (SM) drugs respectively. Results: Out of the total 89 samples analyzed, 13 (14.6%) showed resistance to the first-line drugs while 76 (85.4%) were susceptible. Drug resistance was identified in 10 (11.8%) of the new tuberculosis case (primary drug resistance cases) and 3 (75%) in re-treatment cases (secondary or acquired resistance). Prevalence of mono-resistant, double resistant and triple resistant patterns were 5 (5.7%), 6 (6.7%) and 2 (2.2%) respectively. Multi-drug resistant (resistant to both RIF and INH, the two most potent anti-tuberculosis drugs, with or without resistant to other drugs) was 1.1%. No isolate was resistant to all the four drugs. Conclusion: Drug resistance were observed in the cultures of M. tuberculosis complex, however no isolate showed resistance to all the four first-line drugs used. This study therefore recommends strict adherent to medication for tuberculosis patients as poor compliance or inappropriate use of drugs could induce resistance. Keywords: Drug resistance, M. tuberculosis complex, antimicrobial susceptibility, Abuja, sputum, first-line drugs. General Microbiology Drug resistance M. tuberculosis complex antimicrobial susceptibility Abuja sputum first-line drugs Figures Figure 1 1. Introduction Nigeria is one of the leading countries in the high burden countries for TB/HIV, DR-TB, MDR-TB and XDR-TB with an estimated rate of 322 per 100 000 population with only 15% of the total burden of the disease in the country being reformed in 2015 (WHO, 2017) According to WHO (2017), out of the global rate of 10.4 million incident cases of TB, 3.9% were estimated to have had rifampicin-or Drug resistant tuberculosis whereas 21% of previously treated TB cases were estimated to have had MDR/RR-TB in the same year. Nigeria is one of the leading countries in the high burden countries for TB/HIV, DR-TB, MDR-TB and XDR-TB with an estimated rate of 322 per 100 000 population with only 15% of the total burden of the disease in the country being reformed in 2015 (WHO, 2017). MDR-TB is caused by strains of M. tuberculosis that is resistant to both isoniazid and rifampicin. Drug-resistant TB (DR-TB) patients require prolonged and expensive treatment using second-line medications that are less effective and more toxic (WHO, 2016). Anzaku et al (2017), reported that the control efforts and the burden of drug resistant tuberculosis (TB) is poorly comprehended in resource-limited settings. Multi-drug resistant tuberculosis (MDR-TB) (resistant to rifampicin and isoniazid, the two most powerful first-line TB drugs) could be worse, and the emergence of more potent extensively drug-resistant (XDR) M. tuberculosis (defined as resistant to at least isoniazid, rifampin, any fluoroquinolone, and either aminoglycosides [amikacin, kanamycin] or streptomycin or both) in Africa and worldwide has been a major challenge in tuberculosis control worldwide (WHO, 2012). As part of the strategies to trash tuberculosis, the Nigerian government established the National TB and Leprosy Control Programme (NTBLCP) in 1991 and subsequently adopted the WHO-recommended Directly Observed Treatments (DOTs) strategy in 1993 to checkmate the scourge of TB (PHW, 2006). DOTs has since expanded from its previous 47% coverage areas of 1995 to the present 75% (WHO, 2008) with little impact on TB spread as Nigeria stands shoulder high among the 22 high burden countries with new cases. The current cases detection rate of 20% and treatment success of 75% (WHO, 2008) has not fully meet up with the universally recommended 70% new sputum smear-positive case detection arising per year and 85% successful treatment of such cases (Dye et al ., 2007). Between 1995 and 2006 the case detection rate has increased from 11 percent to 20 percent while the treatment success rate slipped from 49% in 1995 to 32% in 1996 and picked in 1997 to 73% (WHO, 2015). The treatment success rate has maintained the above 70% since then. The 2004 incidence figure of tuberculosis was 290/100,000 persons per year or 373, 682 new TB cases of which 33,755 (126/100,000) were smear positive (WHO, 2016). However, the new WHO report (WHO, 2015) put the incidence case at 311/100,000 person or estimated 450,000 new cases of which 137/100000 or 198, 300 persons are smear positive. Although the true level of drug resistance tuberculosis in the world today is unknown, studies have shown that it has been increasing (Espinal et al ., 2011). Drug resistant surveillance commenced in the developed world in the early 1990s but the true incidence remained unclear in the developing world where there is neither no or limited access to testing for drug susceptibility (Cohn et al ., 2010). An estimated 4% of the world’s tuberculosis cases are resistant to at least one of the current first-line drugs (Moran, 2014). WHO reported global burden of drug resistant tuberculosis data in order to determine the global magnitude of resistance to the first-line antituberculosis drugs and by 2003, the third round of the global project (WHO, 2004). Despite strategies to curb emergence of drug resistance tuberculosis, most TB drugs are increasingly becoming resistance (WHO, 2009). This study was conducted to determine the prevalence of anti-tuberculosis drug resistance in a selected district hospital in Abuja, a section of Nigeria. 2.0 Materials and Methods De-identified sputum specimens obtained from suspected TB patients attending Asokoro District Hospital (ADH), Abuja collected from the laboratory between February 2015 and July 2016 were studied in the Research Laboratory of Zankli Medical Centre in Abuja. 2.1 Ethical clearance and informed consent form Approval for the study was obtained from Asokoro Disctrict Hospital Ethic Committe and sputum from patients with no reported history of prior antituberculosis treatment and those that have previously accessed therapy but not on TB treatment as at the start of this work were used. Patients were properly counselled on the importance of the study and Informed consent was obtained from all participants. Those below 18 years had their parents or guidance endorsed the consent in proxy. Both patients and the hospital management were also informed that the study would not interfere with the patients’ management. 2.2 Sputum sample processing Sputum specimens were processed according to standard mycobacteriological culture method while Mycobacterium tuberculosis complexwere identified by microscopy, morphology and biochemical tests respectively(WHO, 2015). Sputum specimens were digested and decontaminated using the modified Petroff’s method (WHO, 1998). 100 µl of sediments (decontaminant) from each specimen was cultured on LJ media and incubated at 37°C for 30days to observe for growth. The isolates were confirmed as M. tuberculosis complex (MTBC) by cultural characteristics, nitrate reduction test, 68 O C catalase test and Ziehl Neelsen smear to observe the serpentine cords typical of MTBC. Drug susceptibility of the isolates to Rifampicin, Isoniazid, Ethambuthol and Streptomycin was done by Proportion method (Kehinde, 2012). The recommended critical concentrations for the drugs were 4µg/ml for SM, 0.2µg/ml for INH, 40µg/ml for RIF and 2µg/ml for EMB respectively. The drug resistant was determined by the ratio of number of colonies growing in drug-containing medium and on drug-free medium and more than 1% increase was considered to be resistant (Vareldzis et al. , 1994; Canetti et al. , 1969; Canetti et al., 1963). 2.3 Primary resistance Primary resistance was classified as resistance to at least one of the drugs tested on the isolates from patient without prior history of anti-tuberculosis therapy while acquired resistant was classified as resistance of isolate obtained from patient that has previously being treated for tuberculosis. Multidrug resistant tuberculosis (MDR-TB) was classified as resistant to at least both the rifampicin and isoniazid. Statistical analysis was done using OpenEpi version 2.2 software packages with variables subjected to Pearson’s Chi-squared tests or Fisher exact tests when numbers were small. 3.0 Results and discussion The growth response of the sputum specimens on LJ media is summarized below. Of three hundred and one (301) AFB+ and – cultures studied, ninety-seven (97) mycobacteria isolates grew, 190 did not grow and the remaining 14 were contaminated. Of the 97 isolates, 89 were MTB complex while 8 were identified as non-tuberculous mycobacteria (NTM) (Table 1). Table 1: Culture status of AFB+/- sputum specimens on LJ media The result of anituberculosis of the drug resistance tuberculosis to both the first line drugs and second line drugs is presented in table 2 below. The prevalence of drug resistance in this study was 14.6% while 85.4% were susceptible. Primary drug resistance was 11.8% (10/85) while secondary or acquired resistance was 5% (3/4) respectively. The overall prevalence of MDR-TB was 1.1%. Mono-resistant TB case was 5.7% with the highest occurring from streptomycin resistant 3.4% follow by ethambutol 2.3%. Double resistant TB case was 6.7% with combination of rifampicin-streptomycin (1.1%) and isoniazid-streptomycin combination (5.6%). Triple resistant tuberculosis case prevalence was 2.2%. Rifampicin-isoniazid-streptomycin combination and isoniazid-ethambutol-streptomycin combination were the only two identified cases in this category. The prevalence of rifampicin-isoniazid-streptomycin resistance was 1.1% and that of isoniazid-ethambutol-streptomycin was also 1.1%. From this study, double resistance had the highest prevalence rate (6.7%) follow by mono-resistant (5.7%) and triple resistant (2.2%) which had the lowest rate. The figure below showed the percentage profile of the resistance prevalent. Table 2: Prevalence of drug resistance tuberculosis= (14.6%) Table 3. Drug Resistant profile of M. tuberculosis complex isolates from Asokoro District Hospital, Abuja. Figure 1 below showed total tested isolates, resistance isolates and susceptible isolates to antituberculosis agents. 2.2 Discussion The prevalence of drug resistance in this study was 14.6%. Levels of primary and secondary drug resistance are 11.8 % and 75% respectively among suspected tuberculosis patients attending the district hospital in Abuja. The level of acquired resistant in this study is significantly higher than the primary resistant (p=0.016). Meanwhile, the primary and acquired drug resistance fall below the acceptable limit for country with well implemented national tuberculosis control programme. Level of acquired drug resistance is between 50%-80% where the national tuberculosis control programme is poorly implemented (Crofton et al ., 2012). As acquired drug resistance determines the occurrence of primary resistance, the latter is expected to be lower than the former (Chaulet et al., 2015). Okodua et al. (2012), asserted that primary drug resistant tuberculosis is 5% or less and acquired drug resistant to decrease to between 10%-20% where DOTS program is well implemented. This study shows 1.1% rate of multi-drug resistant tuberculosis (MDR-TB) which was in contrast to Lawson et al ., (2011) that reported 8% cases of MDRTB. This could be as a result of three (3) cities covered for their study and a larger sample size as compared to one district hospital for this present study. The prevalence of MDR-TB among the re-treatment cases in this study was 25%. This was about similar to nationwide survey report of 25.6% in China (WHO, 2010) and contrary to another study from Jos (a North central city in Nigeria) that reported 18% of retreatment cases (Ani et al., 2009). This could be because most patients accessing the DOTS may not have enough information on importance of drug adherence as it is often noticed that they stop their regimen without completing it once they get relief (PHW, 2006). MDR-TB is a public health concern as it accounts for TB treatment failure worldwide (WHO, 2014). Identifying patients with MDR-TB earlier enables rapid treatment which increases their chances of survival and minimizes risk of transmission (Breathnach et al ., 2008). However, treatment of MDR-TB is complicated because it requires the use of second-line drugs for ≥ 24 months which are more costly, toxic, and less effective than the first-line drugs used for regular tuberculosis therapy (Shah. et al ., 2007). The results of monoresistant pattern showed 5.7% prevalence. Resistant to specific drug indicates that Streptomycin and ethambutol are observed with prevalence of 3.4% and 2.3% respectively. The range of resistant to these two drugs is also in consistent with the world report resistant range of 0-4.9% for Streptomycin and 0-4.2% for ethambutol respectively found in countries with cases of monoresistant tuberculosis challenge (WHO, 2004). Double resistant pattern in this study show resistant MTB isolates to: (1) 5.6% prevalence in Isoniazid and streptomycin combination. (2) 1.1% prevalence in Rifampicin and streptomycin combination. The Isoniazid and streptomycin combination prevalence could be because they are among the first few anti-TB in existence since middle of nineteen century, hence resistant to these two old drugs may have developed over the years (Bello, 2014). Of concern is the isolate resistant to both rifampicin and streptomycin (1.1%). Although MDR-TB is resistant to at least rifampin and isoniazid, the two most powerful and commonly used anti-TB drugs WHO (2014), resistant to RIF alone can be a useful surrogate marker for MDR-TB (Sam et al ., 2006; WHO, 2004a; Somoskovi et al ., 2001). MDR-TB threatens the effectiveness of chemotherapy for both treatment and control of TB and require the use of second-line drugs that are more expensive, less effective than the first-line drugs, toxic and require longer administration periods (18-24 months) (Prammananan et al ., 2005; Moran, 2004). Mortality among cases of MDR-TB is high and this is worrisome because of its high treatment failure rate. Idigbe et al. (2002), reported that 56% of the strains recovered from 96 patients not responding to anti-TB treatment were resistant to one or more of the drugs used, with 38% being resistant to isoniazid, although only 2% were resistant to rifampicin at that time. Triple resistant pattern of the MTB in this study show: (1) 1.1% prevalence of Rifampicin, isoniazid and streptomycin combination. (2) 1.1% prevalence of Isoniazid, ethambutol and streptomycin combination. Isolate showing resistant to rifampicin and isoniazid with or without other first line drug is classified to be a MDR-TB (Sam et al ., 2006; WHO, 2004a; Somoskovi et al ., 2001), often identified with high mortality among the victims and threat to TB treatment and control. The second triple resistant case may be because these drugs were among the first anti-tuberculosis drugs (especially for isoniazid and streptomycin) (Johnson et al ., 2007; Crofton and Mitchison, 1948), and it being abused or inappropriately used over the years. However, EMB resistant in this triple resistant may not be categorical because phenotypic determination of true resistant to EMB is still unclear (Johnson et al ., 2007; Johnson et al ., 2006). The overall drug resistant TB rate of 14.6% found in this study is attributable to poor compliance with the DOTS guidelines common in low-income countries (Jones-Lopez and Ellnerr, 2005), irrational use of drugs as common in countries that sell antimicrobial drugs without prescription (i.e., over-the-counter) (Stratchounski et al ., 2013; Okumura et al ., 2012), lack of the DOTS in parts of the remote areas in the country (PHW, 2006), proliferation of unregistered drug distributors in resource poor settings like Nigeria, inadequate awareness about tuberculosis (its mode of infection and treatment), poor socio-economic condition, HIV/AIDS as well as illiteracy. 4.0 Conclusion and recommendation Drug resistance were observed in the identified cultures of M. tuberculosis complex, however no isolate showed resistance to all the four first-line drugs used. This study therefore recommends strict adherent to medication for tuberculosis patients as poor compliance or inappropriate use of drugs could induce resistance. Strengthening Laboratory capacity that include drug resistance surveillance in Nigeria should be encouraged. This could be done through the provision of faster, automated culture and DST facilities or automated polymerase chain reaction (PCR) technologies that are emerging elsewhere. Future studies should investigate if extensively drug resistant TB (XDR-TB) strains are also affecting newly diagnosed patients with TB in Nigeria and if strains are still sensitive to fluroquinolones and other alternative agents. Declarations Competing interest All authors have declared that, no conflict of interest exist in this manuscript. Ethical clearance: The ethical clearance for this study was obtained from the Ethic Committee of Asokoro District Hospital, Abuja, Nigeria. 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Multidrug and Extensively Drug-Resistant TB (M⁄XDR-TB). 2010 Global Report on Surveillance and Response. WHO, Geneva, Switzerland. World Health Organisation. Global Tuberculosis Control: WHO report 2016. Geneva, Switzerland: World Health Organisation, 2016. Tables Table 1: Culture status of AFB+/- sputum specimens on LJ media Status Isolates Percentage occurrence MTB complex 89 29.6 NMTB 8 2.7 Contaminated No growth 14 190 4.7 63.1 Total 301 100% Key: MTB=Mycobacterium tuberculosis; NMTB= Non Mycobacterium tuberculosis Table 2: Prevalence of drug resistance tuberculosis= (14.6%) Anti-TB agent Type of resistance MDR-TB Mono resistance Double resistance Triple resistance Percentage occurrence Ethambutol 2.3% 5.7% Streptomycin 3.4% RIF-SM 1.1% 6.7% INH-SM 5.6% RIF-INH-SM 1.1% 2.2% INH-EMB-SM 1.1% Total 1.1% 5.7% 6.7% 2.2% 14.6% Keys: SM=Streptomycin; INH= Isoniazid; EMB=Ethambutol; RIF = Rifampicin Table 3. Drug Resistant profile of M. tuberculosis complex isolates from Asokoro District Hospital, Abuja. AFB+ Resistant Pattern (N=89) (%) OR 95% CI P- value Any Drug (N) * 10 11.8 (10/85) 0.8 0.3-1.9 0.591 Any Drug (RE) * 3 75 (3/4) 16.7 1.7-466.4 0.016 Any Drug (N+RE) * 13 14.6 Reference MDR -TB (N) 0 ╪ 0.0 1.0 0.0-41.3 0.977 MDR -TB (RE) 1 25 (1/4) 29.3 1.5-589.8 0.001 MDR -TB (N+RE) 1 1.1 Reference Monoresistant ┴┴ Rifampicin 0 ╪ 0.0 0.5 0.0-6.6 1.000 Isoniazid 0 ╪ 0.0 0.5 0.0-6.6 1.000 Ethambutol 2 2.3 Reference Streptomycin 3 3.4 1.5 0.2-13.0 0.684 Double resistant ┴┴ Rifampicin + Streptomycin 1 1.1 Reference Isoniazid + Streptomycin 5 5.6 5.2 0.7-125.9 0.120 Triple resistant ┴┴ Rifampicin + Isoniazid + Streptomycin 1 1.1 1.0 0.0-39.4 1.000 Isoniazid + Ethambutol +Streptomycin 1 1.1 Reference Monoresistant ┴┴ 5 5.7 Reference Double resistant ┴┴ 6 6.7 1.2 0.3-4.5 0.768 Triple resistant ┴┴ 2 2.2 0.4 0.1-2.0 0.281 Any Rifampicin resistance * 2 2.2 0.3 0.0-1.3 0.101 Any Isoniazid resistance * 7 7.9 Reference Any Ethambutol resistance * 3 3.4 0.4 0.1-1.6 0.215 Any Streptomycin resistance * 11 12.4 1.6 0.6-4.7 0.335 *=Resistance to drug in question, either alone or in combination with resistance to others; N=New cases; RE=Re-treatment cases; ┴┴= Resistance to the specified drug; MDR-TB= Multidrug resistant tuberculosis; OR=odds ratio; CI= confidence interval. ╪ = calculated by adding 0.5 to numerator and denominator (reference). 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Nigeria is one of the leading countries in the high burden countries\n for TB/HIV, DR-TB, MDR-TB and XDR-TB with an estimated rate of 322 per 100 000 population\n with only 15% of the total burden of the disease in the country being reformed in\n 2015 (WHO, 2017). MDR-TB is caused by strains of M. tuberculosis that is resistant\n to both isoniazid and rifampicin. Drug-resistant TB (DR-TB) patients require prolonged\n and expensive treatment using second-line medications that are less effective and\n more toxic (WHO, 2016). Anzaku \u003cem\u003eet al\u003c/em\u003e (2017), reported that the control efforts and the burden of drug resistant tuberculosis\n (TB) is poorly comprehended in resource-limited settings. \u003c/p\u003e\n \n\u003cp\u003eMulti-drug resistant tuberculosis (MDR-TB) (resistant to rifampicin and isoniazid,\n the two most powerful first-line TB drugs) could be worse, and the emergence of more\n potent extensively drug-resistant (XDR) \u003cem\u003eM. tuberculosis\u003c/em\u003e (defined as resistant to at least isoniazid, rifampin, any fluoroquinolone, and either\n aminoglycosides [amikacin, kanamycin] or streptomycin or both) in Africa and worldwide\n has been a major challenge in tuberculosis control worldwide (WHO, 2012). As part\n of the strategies to trash tuberculosis, the Nigerian government established the National\n TB and Leprosy Control Programme (NTBLCP) in 1991 and subsequently adopted the WHO-recommended\n Directly Observed Treatments (DOTs) strategy in 1993 to checkmate the scourge of TB\n (PHW, 2006). DOTs has since expanded from its previous 47% coverage areas of 1995\n to the present 75% (WHO, 2008) with little impact on TB spread as Nigeria stands shoulder\n high among the 22 high burden countries with new cases. The current cases detection rate of 20% and treatment success of 75% (WHO, 2008)\n has not fully meet up with the universally recommended 70% new sputum smear-positive\n case detection arising per year and 85% successful treatment of such cases (Dye \u003cem\u003eet al\u003c/em\u003e., 2007). Between 1995 and 2006 the case detection rate has increased from 11 percent\n to 20 percent while the treatment success rate slipped from 49% in 1995 to 32% in\n 1996 and picked in 1997 to 73% (WHO, 2015). The treatment success rate has maintained\n the above 70% since then. The 2004 incidence figure of tuberculosis was 290/100,000\n persons per year or 373, 682 new TB cases of which 33,755 (126/100,000) were smear\n positive (WHO, 2016). However, the new WHO report (WHO, 2015) put the incidence case\n at 311/100,000 person or estimated 450,000 new cases of which 137/100000 or 198, 300\n persons are smear positive.\u003c/p\u003e\n \n\u003cp\u003eAlthough the true level of drug resistance tuberculosis in the world today is unknown,\n studies have shown that it has been increasing (Espinal \u003cem\u003eet al\u003c/em\u003e., 2011). Drug resistant surveillance commenced in the developed world in the early\n 1990s but the true incidence remained unclear in the developing world where there\n is neither no or limited access to testing for drug susceptibility (Cohn \u003cem\u003eet al\u003c/em\u003e., 2010). An estimated 4% of the world’s tuberculosis cases are resistant to at least\n one of the current first-line drugs (Moran, 2014). WHO reported global burden of\n drug resistant tuberculosis data in order to determine the global magnitude of resistance\n to the first-line antituberculosis drugs and by 2003, the third round of the global\n project (WHO, 2004). Despite strategies to curb emergence of drug resistance tuberculosis,\n most TB drugs are increasingly becoming resistance (WHO, 2009). This study was conducted\n to determine the prevalence of anti-tuberculosis drug resistance in a selected district\n hospital in Abuja, a section of Nigeria. \u003c/p\u003e"},{"header":"2.0 Materials and Methods ","content":"\u003cp\u003eDe-identified sputum specimens obtained from suspected TB patients attending Asokoro\n District Hospital (ADH), Abuja collected from the laboratory between February 2015\n and July 2016 were studied in the Research Laboratory of Zankli Medical Centre in\n Abuja. \u003c/p\u003e\n \n\u003ch2\u003e2.1 Ethical clearance and informed consent form\u003c/h2\u003e\n \n\u003cp\u003eApproval for the study was obtained from Asokoro Disctrict Hospital Ethic Committe\n and sputum from patients with no reported history of prior antituberculosis treatment\n and those that have previously accessed therapy but not on TB treatment as at the\n start of this work were used. Patients were properly counselled on the importance\n of the study and Informed consent was obtained from all participants. Those below\n 18 years had their parents or guidance endorsed the consent in proxy. Both patients\n and the hospital management were also informed that the study would not interfere\n with the patients’ management. \u003c/p\u003e\n \n\u003ch2\u003e2.2 Sputum sample processing \n \u003c/h2\u003e\n \n\u003cp\u003eSputum specimens were processed according to standard mycobacteriological culture\n method while \u003cem\u003eMycobacterium tuberculosis \u003c/em\u003ecomplexwere identified by microscopy, morphology and biochemical tests respectively(WHO, 2015). Sputum specimens were digested and decontaminated using the modified\n Petroff’s method (WHO, 1998). 100 µl of sediments (decontaminant) from each specimen\n was cultured on LJ media and incubated at 37°C for 30days to observe for growth. \n The isolates were confirmed as M. tuberculosis complex (MTBC) by cultural characteristics,\n nitrate reduction test, 68\u003csup\u003eO\u003c/sup\u003eC catalase test and Ziehl Neelsen smear to observe the serpentine cords typical of MTBC.\u003c/p\u003e\n \n\u003cp\u003eDrug susceptibility of the isolates to Rifampicin, Isoniazid, Ethambuthol and Streptomycin\n was done by Proportion method (Kehinde, 2012). The recommended critical concentrations\n for the drugs were 4µg/ml for SM, 0.2µg/ml for INH, 40µg/ml for RIF and 2µg/ml for\n EMB respectively. The drug resistant was determined by the ratio of number of colonies\n growing in drug-containing medium and on drug-free medium and more than 1% increase\n was considered to be resistant (Vareldzis \u003cem\u003eet al.\u003c/em\u003e, 1994; Canetti \u003cem\u003eet al.\u003c/em\u003e, 1969; Canetti \u003cem\u003eet al.,\u003c/em\u003e 1963).\u003c/p\u003e\n \n\u003ch2\u003e2.3 Primary resistance\u003c/h2\u003e\n \n\u003cp\u003ePrimary resistance was classified as resistance to at least one of the drugs tested\n on the isolates from patient without prior history of anti-tuberculosis therapy while\n acquired resistant was classified as resistance of isolate obtained from patient that\n has previously being treated for tuberculosis. Multidrug resistant tuberculosis (MDR-TB)\n was classified as resistant to at least both the rifampicin and isoniazid. \u003c/p\u003e\n \n\u003cp\u003eStatistical analysis was done using OpenEpi version 2.2 software packages with variables\n subjected to Pearson’s Chi-squared tests or Fisher exact tests when numbers were small.\n \u003c/p\u003e"},{"header":"3.0 Results and discussion ","content":"\u003cp\u003eThe growth response of the sputum specimens on LJ media is summarized below. Of three\n hundred and one (301) AFB+ and – cultures studied, ninety-seven (97) mycobacteria\n isolates grew, 190 did not grow and the remaining 14 were contaminated. Of the 97\n isolates, 89 were MTB complex while 8 were identified as non-tuberculous mycobacteria\n (NTM) (Table 1). \u003c/p\u003e\n \n\u003cp\u003eTable 1: Culture status of AFB+/- sputum specimens on LJ media \u003c/p\u003e\n \n\u003cp\u003eThe result of anituberculosis of the drug resistance tuberculosis to both the first\n line drugs and second line drugs is presented in table 2 below. The prevalence of\n drug resistance in this study was 14.6% while 85.4% were susceptible. Primary drug\n resistance was 11.8% (10/85) while secondary or acquired resistance was 5% (3/4) respectively.\n The overall prevalence of MDR-TB was 1.1%. Mono-resistant TB case was 5.7% with the\n highest occurring from streptomycin resistant 3.4% follow by ethambutol 2.3%. Double\n resistant TB case was 6.7% with combination of rifampicin-streptomycin (1.1%) and\n isoniazid-streptomycin combination (5.6%). Triple resistant tuberculosis case prevalence\n was 2.2%. Rifampicin-isoniazid-streptomycin combination and isoniazid-ethambutol-streptomycin\n combination were the only two identified cases in this category. The prevalence of\n rifampicin-isoniazid-streptomycin resistance was 1.1% and that of isoniazid-ethambutol-streptomycin\n was also 1.1%. From this study, double resistance had the highest prevalence rate\n (6.7%) follow by mono-resistant (5.7%) and triple resistant (2.2%) which had the lowest\n rate. The figure below showed the percentage profile of the resistance prevalent.\u003c/p\u003e\n \n\n \n\u003cp\u003e Table 2: Prevalence of drug resistance tuberculosis= (14.6%)\u003c/p\u003e\n\u003cp\u003e Table 3. Drug Resistant profile of \u003cem\u003eM. tuberculosis \u003c/em\u003ecomplex isolates from Asokoro District Hospital, Abuja.\u003c/p\u003e\n \n\u003cp\u003eFigure 1 below showed total tested isolates, resistance isolates and susceptible isolates\n to antituberculosis agents.\u003c/p\u003e"},{"header":"2.2 Discussion","content":"\u003cp\u003eThe prevalence of drug resistance in this study was 14.6%. Levels of primary and\n secondary drug resistance are 11.8 % and 75% respectively among suspected tuberculosis\n patients attending the district hospital in Abuja. The level of acquired resistant\n in this study is significantly higher than the primary resistant (p=0.016). Meanwhile,\n the primary and acquired drug resistance fall below the acceptable limit for country\n with well implemented national tuberculosis control programme. Level of acquired\n drug resistance is between 50%-80% where the national tuberculosis control programme\n is poorly implemented (Crofton \u003cem\u003eet al\u003c/em\u003e., 2012). As acquired drug resistance determines the occurrence of primary resistance,\n the latter is expected to be lower than the former (Chaulet \u003cem\u003eet al.,\u003c/em\u003e 2015). Okodua \u003cem\u003eet al.\u003c/em\u003e (2012), asserted that primary drug resistant tuberculosis is 5% or less and acquired\n drug resistant to decrease to between 10%-20% where DOTS program is well implemented.\n This study shows 1.1% rate of multi-drug resistant tuberculosis (MDR-TB) which was\n in contrast to Lawson \u003cem\u003eet al\u003c/em\u003e., (2011) that reported 8% cases of MDRTB. This could be as a result of three (3)\n cities covered for their study and a larger sample size as compared to one district\n hospital for this present study. The prevalence of MDR-TB among the re-treatment cases\n in this study was 25%. This was about similar to nationwide survey report of 25.6%\n in China (WHO, 2010) and contrary to another study from Jos (a North central city\n in Nigeria) that reported 18% of retreatment cases (Ani \u003cem\u003eet al.,\u003c/em\u003e 2009). This could be because most patients accessing the DOTS may not have enough\n information on importance of drug adherence as it is often noticed that they stop\n their regimen without completing it once they get relief (PHW, 2006). MDR-TB is a\n public health concern as it accounts for TB treatment failure worldwide (WHO, 2014).\n Identifying patients with MDR-TB earlier enables rapid treatment which increases their\n chances of survival and minimizes risk of transmission (Breathnach \u003cem\u003eet al\u003c/em\u003e., 2008). However, treatment of MDR-TB is complicated because it requires the use\n of second-line drugs for ≥ 24 months which are more costly, toxic, and less effective\n than the first-line drugs used for regular tuberculosis therapy (Shah. \u003cem\u003eet al\u003c/em\u003e., 2007). The results of monoresistant pattern showed 5.7% prevalence. Resistant\n to specific drug indicates that Streptomycin and ethambutol are observed with prevalence\n of 3.4% and 2.3% respectively. The range of resistant to these two drugs is also\n in consistent with the world report resistant range of 0-4.9% for Streptomycin and\n 0-4.2% for ethambutol respectively found in countries with cases of monoresistant\n tuberculosis challenge (WHO, 2004).\u003c/p\u003e\n \n\u003cp\u003eDouble resistant pattern in this study show resistant MTB isolates to: (1) 5.6% prevalence\n in Isoniazid and streptomycin combination. (2) 1.1% prevalence in Rifampicin and\n streptomycin combination. The Isoniazid and streptomycin combination prevalence \n could be because they are among the first few anti-TB in existence since middle of\n nineteen century, hence resistant to these two old drugs may have developed over the\n years (Bello, 2014). Of concern is the isolate resistant to both rifampicin and streptomycin\n (1.1%). Although MDR-TB is resistant to at least rifampin and isoniazid, the two\n most powerful and commonly used anti-TB drugs WHO (2014), resistant to RIF alone can\n be a useful surrogate marker for MDR-TB (Sam \u003cem\u003eet al\u003c/em\u003e., 2006; WHO, 2004a; Somoskovi \u003cem\u003eet al\u003c/em\u003e., 2001). MDR-TB threatens the effectiveness of chemotherapy for both treatment and\n control of TB and require the use of second-line drugs that are more expensive, less\n effective than the first-line drugs, toxic and require longer administration periods\n (18-24 months) (Prammananan \u003cem\u003eet al\u003c/em\u003e., 2005; Moran, 2004). Mortality among cases of MDR-TB is high and this is worrisome\n because of its high treatment failure rate.\n Idigbe \u003cem\u003eet al.\u003c/em\u003e (2002), reported that 56% of the strains recovered from 96 patients not responding\n to anti-TB treatment were resistant to one or more of the drugs used, with 38% being\n resistant to isoniazid, although only 2% were resistant to rifampicin at that time.\n Triple resistant pattern of the MTB in this study show: (1) 1.1% prevalence of Rifampicin,\n isoniazid and streptomycin combination. (2) 1.1% prevalence of Isoniazid, ethambutol\n and streptomycin combination. Isolate showing resistant to rifampicin and isoniazid\n with or without other first line drug is classified to be a MDR-TB (Sam \u003cem\u003eet al\u003c/em\u003e., 2006; WHO, 2004a; Somoskovi \u003cem\u003eet al\u003c/em\u003e., 2001), often identified with high mortality among the victims and threat to TB\n treatment and control. The second triple resistant case may be because these drugs\n were among the first anti-tuberculosis drugs (especially for isoniazid and streptomycin)\n (Johnson \u003cem\u003eet al\u003c/em\u003e., 2007; Crofton and Mitchison, 1948), and it being abused or inappropriately used\n over the years. However, EMB resistant in this triple resistant may not be categorical\n because phenotypic determination of true resistant to EMB is still unclear (Johnson\n \u003cem\u003eet al\u003c/em\u003e., 2007; Johnson \u003cem\u003eet al\u003c/em\u003e., 2006).\u003c/p\u003e\n \n\n \n\u003cp\u003eThe overall drug resistant TB rate of 14.6% found in this study is attributable to\n poor compliance with the DOTS guidelines common in low-income countries (Jones-Lopez\n and Ellnerr, 2005), irrational use of drugs as common in countries that sell antimicrobial\n drugs without prescription (i.e., over-the-counter) (Stratchounski \u003cem\u003eet al\u003c/em\u003e., 2013; Okumura \u003cem\u003eet al\u003c/em\u003e., 2012), lack of the DOTS in parts of the remote areas in the country (PHW, 2006),\n proliferation of unregistered drug distributors in resource poor settings like Nigeria,\n inadequate awareness about tuberculosis (its mode of infection and treatment), poor\n socio-economic condition, HIV/AIDS as well as illiteracy. \u003c/p\u003e"},{"header":"4.0 Conclusion and recommendation","content":"\u003cp\u003eDrug resistance were observed in the identified cultures of \u003cem\u003eM. tuberculosis\u003c/em\u003e complex, however no isolate showed resistance to all the four first-line drugs used.\n This study therefore recommends strict adherent to medication for tuberculosis patients\n as poor compliance or inappropriate use of drugs could induce resistance.\u003c/p\u003e\n \n\u003cp\u003eStrengthening Laboratory capacity that include drug resistance surveillance in Nigeria\n should be encouraged. This could be done through the provision of faster, automated\n culture and DST facilities or automated polymerase chain reaction (PCR) technologies\n that are emerging elsewhere. Future studies should investigate if extensively drug\n resistant TB (XDR-TB) strains are also affecting newly diagnosed patients with TB\n in Nigeria and if strains are still sensitive to fluroquinolones and other alternative\n agents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting interest\u003c/h2\u003e\n \n\u003cp\u003eAll authors have declared that, no conflict of interest exist in this manuscript.\u003c/p\u003e\n \n\u003ch2\u003eEthical clearance:\n \u003c/h2\u003e\n \n\u003cp\u003eThe ethical clearance for this study was obtained from the Ethic Committee of Asokoro\n District Hospital, Abuja, Nigeria. Participants for this study were allowed to voluntarily\n participate after obtaining informed consent forms.\u003c/p\u003e\n \n\u003ch2\u003eAcknowledgement:\u003c/h2\u003e\n \n\u003cp\u003eWe will like to thank the Asokoro District Hospital, Abuja for study approval and\n Zankli Medical Centre for supporting the research. \u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eAni AE, Daylop YB, Agbaji O \u0026amp; Idoko J (2009). Drug susceptibility test of Mycobacterium\n \n tuberculosis by nitrate reductase assay. Journal of Infection in Developing Countries\n 3: 16–\n 19.\u003c/p\u003e\n \n\n \n\u003cp\u003eBello LA, Shittu MO, Shittu BT, Oluremi AS, Akinnuroju ON, Adekola SA. Rifampicin-\n monoresistant Mycobacterium tuberculosis among the patients visiting chest clinic,\n state \n specialist hospital, Akure, Nigeria. Int J Res Med Sci. 2014; 2:1134–1137.\u003c/p\u003e\n \n\u003cp\u003eBreathnach, A.S., de Ruiter, A., Holdsworth, G.M., Bateman, N.T., O’Sullivan, D.G\n and Rees, \n P.J. (2008). An outbreak of multidrug resistant tuberculosis in a London teaching\n hospital. \n \u003cem\u003eJ. Hosp. Infect\u003c/em\u003e. \u003cem\u003e39\u003c/em\u003e:111-7. \u003c/p\u003e\n \n\u003cp\u003eChaulet, P., Boulahbal, F., and Grosset, J. (2015). Surveillance of drug resistance\n for tuberculosis control: why and how? \u003cem\u003eTuberc. Lung Dis\u003c/em\u003e. 76 (6): 487-492.\u003c/p\u003e\n \n\n \n\u003cp\u003eCrofton, J., Chauletxs nx, P., and Maher. D (2012). Guidelines for the management\n of drug-\n resistant tuberculosis. WHO/TB/96.210 (Rev.1). World Health Organization, Geneva,\n \n Switzerland.\u003c/p\u003e\n \n\n \n\u003cp\u003eCanetti, G., Fox, W., Khomenko, A., Mahler, H.T., Menon, N.K., Mitchison, D.A., \u003cem\u003eet al.,\u003c/em\u003e (1969). \n Advances in techniques of testing mycobacterial drug sensitivity, and the use of \n sensitivity tests in tuberculosis control programmes. \u003cem\u003eBull World Health Organ 41: \u003c/em\u003e21-43\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n \n\n \n\u003cp\u003eCanetti, G., Froman, S., Grosset, J \u003cem\u003eet al\u003c/em\u003e., (1963). Mycobacteria: laboratory methods for testing \n drug sensitivity and resistance. \u003cem\u003eBull World Health Organ 29\u003c/em\u003e: 565-78.\u003c/p\u003e\n \n\n \n\u003cp\u003eChaulet, P., Boulahbal, F., and Grosset, J. (1995). Surveillance of drug resistance\n for \n tuberculosis control: why and how? \u003cem\u003eTuberc. Lung Dis\u003c/em\u003e. 76 (6): 487-492.\u003c/p\u003e\n \n\n \n\u003cp\u003eCohn, D.L., Bustreo, F., and M.C. Raviglione (1997). Drug-resistant tuberculosis:\n review of \n worldwide situation and the WHO/IUATLD Global Surveillance Project. \u003cem\u003eClin. Infect. \n Dis. 24 Suppl 1\u003c/em\u003e, S121-S130.\u003c/p\u003e\n \n\n \n\u003cp\u003eCrofton, J., Chauletxs nx, P., and Maher. D (1997). Guidelines for the management\n of drug-\n resistant tuberculosis. WHO/TB/96.210 (Rev.1). World Health Organization, Geneva,\n \n Switzerland.\u003c/p\u003e\n \n\n \n\u003cp\u003eCrofton, J. (1994). Multidrug resistance: danger for the Third World. In Porter JDH,\n McAdam, \n KDNJ. Editors: “Tuberculosis back to the future”, Chichester, John Wiley \u0026amp; Sons Ltd.,\n \n 231-233.\u003c/p\u003e\n \n\n \n\u003cp\u003eCrofton, J and Mitchison, D.A. (1948). Streptomycin resistance in pulmonary tuberculosis.\n \u003cem\u003eBrit. \n Med. J. 2\u003c/em\u003e:1009-1015.\u003c/p\u003e\n \n\n \n\u003cp\u003eBarnes, P.F., and Barrows, S.A (1993). Tuberculosis in the 1990’s. \u003cem\u003eAnn Intern Med 119: \u003c/em\u003e400-10.\u003c/p\u003e\n \n\n \n\u003cp\u003eBloch, A.B., Cauthen, G.M., and Onorato, I.M. (1994). Nationwide survey of drug-resistant\n \n tuberculosis in the United States. \u003cem\u003eJ. Amer. Med. Assoc. 271\u003c/em\u003e:665-671.\u003c/p\u003e\n \n\u003cp\u003eBreathnach, A.S., de Ruiter, A., Holdsworth, G.M., Bateman, N.T., O’Sullivan, D.G\n and Rees, \n P.J. (1998). An outbreak of multidrug resistant tuberculosis in a London teaching\n hospital. \n \u003cem\u003eJ. Hosp. Infect\u003c/em\u003e. \u003cem\u003e39\u003c/em\u003e:111-7. \u003c/p\u003e\n \n\u003cp\u003eBraun, M.M., Kilburn, J.O., Smithwick, R.W, \u003cem\u003eet al.,\u003c/em\u003e (1992). HIV infection and primary \n resistance to antituberculosis drugs in Abidjan, Cote d’Ivoire. \u003cem\u003eAIDS 6\u003c/em\u003e: 1327-1330.\u003c/p\u003e\n \n\n \n\u003cp\u003eDye, C., Hosseini, M., and C. Watt (2007). Did we reach the 2005 target hjhijio for\n tuberculosis \n control? \u003cem\u003eBull World Health Organ 85\u003c/em\u003e: 364-9.\u003c/p\u003e\n \n\n \n\u003cp\u003eDonald, E., and A. V. Rie (2006).XDR tuberculosis: an indicator of public health\u003c/p\u003e\n \n\u003cp\u003e\n Negligence. \u003cem\u003eLancet 368\u003c/em\u003e:1554–1556.\u003c/p\u003e\n \n\u003cp\u003eDrobniewski, F., Eltringham, I., Graham, C., Magee, J.G., Smith, E.G and Watt, B.\n (2002). A \n national study of clinical and laboratory factors affecting the survival of patients\n with \n multiple drug resistant tuberculosis in the UK. \u003cem\u003eThorax 57\u003c/em\u003e: 810-6. \u003c/p\u003e\n \n\u003cp\u003eDye, C., Hosseini, M., and C. Watt (2007). Did we reach the 2005 target hjhijio for\n tuberculosis \n control? \u003cem\u003eBull World Health Organ 85\u003c/em\u003e: 364-9.\u003c/p\u003e\n \n\n \n\u003cp\u003eEspinal, M.A., Adalbert, P.H., Laszlo, A.L., \u003cem\u003eet al.,\u003c/em\u003e (2003). Global trends in resistance to \n antituberculosis drugs. \u003cem\u003eN Engl J Med 344\u003c/em\u003e: 1294-303.\u003c/p\u003e\n \n\u003cp\u003eEspinal, M.A., Laserson,K., Camacho, M., Fusheng, Z., Kim, S.J., Tlali, R.E., Smith,\n I., Suarez, \n P., Atunes, M.L George, A.G., Martin-Casabona, N., Simelane, P., Weyer, K., Binkin,\n N., \n Raviglione, M,C (2001). Determinants of drug-resistant tuberculosis: analysis of\n 11 \n countries\u003cem\u003e. Int J Tuberc Lung Dis 5\u003c/em\u003e(10): 887-893.\u003c/p\u003e\n \n\u003cp\u003e\n Raviglione, M,C (2001). Determinants of drug-resistant tuberculosis: analysis of\n 11 \n countries\u003cem\u003e. Int J Tuberc Lung Dis 5\u003c/em\u003e(10): 887-893.\u003c/p\u003e\n \n\n \n\u003cp\u003eGandhi, N. R., A. Moll, A. W. Sturm, R. Pawinski, T. Govender, U. Lalloo, K. Zeller,\n J. Andrews, \n and G. Friedland (2006). Extensively drug-resistant tuberculosis as a cause of death\n in \n patients co-infected with tuberculosis and HIV in a rural area of South Africa. \u003cem\u003eLancet\u003c/em\u003e \n \u003cem\u003e368\u003c/em\u003e:1575–1580.\u003c/p\u003e\n \n\u003cp\u003eGrange, J.M., and Zuma, A (2002). The global emergency of tuberculosis: What is the\n cause? \u003cem\u003eJ. \n Royal Soc Health 122\u003c/em\u003e: 78-81.\u003c/p\u003e\n \n\n \n\u003cp\u003eGupta, R., Kim, J.Y., Espinal, M.A., Caudron, J.M., Farmer, P.E., and Raviglione,\n M.C. (2001). \n Responding to market failures in tuberculosis: a model to increase access to drugs\n and \n treatment. \u003cem\u003eScience 293\u003c/em\u003e:1049-51. \u003c/p\u003e\n \n\n \n\u003cp\u003eHorsburgh, C.R. (2000). The global problem of multidrug-resistant tuberculosis: The\n genie is out \n of the bottle. \u003cem\u003eJ. Amer. Med. Assoc. 283\u003c/em\u003e:2575-2576.\u003c/p\u003e\n \n\u003cp\u003eIdigbe EO, Duque JP, John EK, Annam O. Resistance to antituberculosis drugs in treated\n patients \n in Lagos, Nigeria. J Trop Med Hyg 1992;95:186-91.\u003c/p\u003e\n \n\u003cp\u003eJohnson, R., Streicher, E.M., Louw, G.E., Warren, R.M., van Helden, P.D., and Victor.T.C\n \n (2007). Drug resistance in \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e. \u003cem\u003eMol Biol 8\u003c/em\u003e: 97-112. \u003c/p\u003e\n \n\n \n\u003cp\u003eJordaan R, A.M., Pretorius, L., Engelke, E., van der, S.G.,Kewley, C., Bosman, M.,\n van Helden, \n P.D., Warren, R., and Victor, T.C (2006). Ethambutol resistant testing by mutation\n \n detection. \u003cem\u003eInt. J. \u003c/em\u003eJohnson\u003cem\u003e Tuberc. Lung Dis 10\u003c/em\u003e: 68-73.\u003c/p\u003e\n \n\n \n\u003cp\u003eKehinde AO, Adetoye AE. Diagnosis of pulmonary tuberculosis using genotype MTBDRPLUS\n \n assay in three local government primary health centres of Osun State, Nigeria- a pilot\n study. \n J Med Microb Diagn. 2012; S3:001.\u003c/p\u003e\n \n\n \n\u003cp\u003eKenyon, T.A., Mwasekaga, M.J., Huebner, R., Rumisha, D., Binkin, N., and E. Maganu\n (1999). \n Low levels of drug resistance amidst rapidly increasing tuberculosis and human \n immunodeficiency virus co-epidemics in Botswana. \u003cem\u003eInt J Tuberc Lung Dis 3(1)\u003c/em\u003e: 4-11\u003c/p\u003e\n \n\n \n\u003cp\u003eKochi, A., Vareldzis, B., Styblo, K. (1994). Multidrug resistant tuberculosis and\n its control. \n \u003cem\u003eRes. Microbiol\u003c/em\u003e., \u003cem\u003e144\u003c/em\u003e: 104-110.\u003c/p\u003e\n \n\u003cp\u003eLawson L, Yassin M A, Abdurrahman ST. \u003cem\u003eet al.,\u003c/em\u003e (2011). Resistance to first-line tuberculosis drugs \n in three cities of Nigeria. \u003cem\u003eTropical Medicine and International Health\u003c/em\u003e 16 (8) pp 974–980\u003c/p\u003e\n \n\n \n\u003cp\u003eMoran, M. (2014). Running out of breath? TB care in the 21st century. \u003cem\u003eMSF.\u003c/em\u003e pp. 1-32.\u003c/p\u003e\n \n\u003cp\u003e\n Kent, P. T., and G. P. Kubica (1985).Public health mycobacteriology: a guide for the\n \n level III laboratory. Centers for Disease Control, Atlanta, GA.\u003c/p\u003e\n \n\n \n\u003cp\u003eMoran, M. (2004). Running out of breath? TB care in the 21st century. \u003cem\u003eMSF.\u003c/em\u003e pp. 1-32.\u003c/p\u003e\n \n\n \n\u003cp\u003eNathanson, E., Lambregts-van, W.C., Rich, M.L., Gupta, R., Bayona, J., Blondal, K.,\n \u003cem\u003eet al.,\u003c/em\u003e (2006). \n Multi-drug resistant tuberculosis management in resource-limited settings.\u003cem\u003e Emerg Infect \n Dis 12: \u003c/em\u003e1389-97.\u003c/p\u003e\n \n\n \n\u003cp\u003eOkodua M, Ihongbe J, Esumeh F. Pulmonary tuberculosis and resistance pattern to first\n line \n antituberculosis drugs in a city of western Nigeria. Int J Basic Appl Innov Res. 2012;\n 1: \n 48–56.\u003c/p\u003e\n \n\n \n\u003cp\u003eOluwaseun E, Akinniyi AP, Afolabi O. Primary multi-drug resistant tuberculosis among\n HIV \n seropositive and seronegative patients in Abeokuta, southwestern Nigeria. Am J Res\n \n Comm. 2013; 1:224–237.\u003c/p\u003e\n \n\n \n\u003cp\u003ePrammananan, T., Arjatankool, W., Chaiprasert, A., Tingtoy, N., Leechawengwong, M.,\n \n Aswapokee, N., Leelaramasae, A., and Dhiraputra, C (2005). Second-line susceptibilities\n \n of Thai multidrug-resistant \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e isolates. \u003cem\u003eIntl J Tuberc Lung Dis. \n 9: \u003c/em\u003e216-9.\u003c/p\u003e\n \n\n \n\u003cp\u003eWHO (2010). Multidrug and Extensively Drug-Resistant TB (M⁄XDR-TB). 2010 Global Report\n \n on Surveillance and Response. WHO, Geneva, Switzerland.\u003c/p\u003e\n \n\n \n\u003cp\u003eWorld Health Organisation. Global Tuberculosis Control: WHO report 2016. Geneva, \n Switzerland: World Health Organisation, 2016.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style=\"text-align: justify;\"\u003eTable 1:\u003cstrong\u003e Culture status of AFB+/- sputum specimens on LJ media\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: justify; tab-stops: 65.3pt 91.25pt 117.0pt 325.5pt 345.0pt;\"\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"width: 359.75pt; border-collapse: collapse; border: none;\" width=\"480\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 162.9pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"217\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%; tab-stops: 65.3pt;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eStatus\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58.5pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"78\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eIsolates\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 138.35pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"184\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003ePercentage occurrence \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 162.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"217\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%; tab-stops: 51.0pt;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eMTB complex \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58.5pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"78\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e89\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 138.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"184\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u0026nbsp; 29.6\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 162.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"217\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eNMTB\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58.5pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"78\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e8\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 138.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"184\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u0026nbsp; 2.7\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 162.9pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"217\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eContaminated \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"color: windowtext;\"\u003eNo growth\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58.5pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"78\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e14\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"color: windowtext;\"\u003e190\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 138.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"184\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u0026nbsp; 4.7\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u0026nbsp; 63.1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 162.9pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"217\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"78\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e301\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 138.35pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"184\"\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u0026nbsp; 100%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: justify; tab-stops: 63.75pt;\"\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: justify;\"\u003e\u003cstrong\u003eKey:\u003c/strong\u003e MTB=Mycobacterium tuberculosis; NMTB= Non Mycobacterium tuberculosis\u003c/p\u003e\n\u003cp style=\"text-align: justify; line-height: 200%;\"\u003e\u0026nbsp;Table 2: \u003cstrong\u003e\u0026nbsp;Prevalence of drug resistance tuberculosis= (14.6%)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 422.75pt; border-collapse: collapse; border: none; margin-left: 6.75pt; margin-right: 6.75pt;\" width=\"564\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eAnti-TB agent\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 333.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"5\" width=\"444\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003cstrong\u003eType of resistance \u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eMDR-TB\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eMono \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eresistance\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eDouble resistance\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eTriple \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eresistance\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003ePercentage occurrence\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eEthambutol\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"6\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e2.3%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"2\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"4\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"2\" width=\"96\"\u003e\n\u003cp style=\"line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e5.7% \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eStreptomycin\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e3.4%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eRIF-SM\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"4\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e1.1%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"2\" width=\"96\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e6.7%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eINH-SM\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e5.6%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eRIF-INH-SM\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"2\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e1.1%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" rowspan=\"2\" width=\"96\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e2.2%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003eINH-EMB-SM\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cspan style=\"color: windowtext;\"\u003e1.1%\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 89.75pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"120\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003eTotal \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e1.1%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 67.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"90\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e5.7%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e6.7%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"84\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e2.2%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.0in; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"96\"\u003e\n\u003cp style=\"text-align: justify; line-height: 115%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: windowtext;\"\u003e14.6%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"color: red;\"\u003e\u003cbr /\u003e\u003c/span\u003e\u003c/strong\u003eKeys: SM=Streptomycin; INH= Isoniazid; EMB=Ethambutol; RIF = Rifampicin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"color: red;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u0026nbsp; Drug Resistant profile of \u003cem\u003eM. tuberculosis \u003c/em\u003ecomplex isolates from Asokoro District Hospital, Abuja.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003cstrong\u003eAFB+ \u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eResistant Pattern\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; (N=89) \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;(%)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; OR\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 95% CI \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; P- value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Drug (N)\u003cstrong\u003e *\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 10\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 11.8 (10/85)\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.8\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.3-1.9 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.591\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Drug (RE)\u003cstrong\u003e *\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 3\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 75 (3/4)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 16.7\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.7-466.4\u003csup\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/sup\u003e0.016\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Drug (N+RE)\u003cstrong\u003e *\u003c/strong\u003e \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 13\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 14.6\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eMDR\u003c/span\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e-TB (N)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0\u003csup\u003e╪\u003c/sup\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.0\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0-41.3 \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.977\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eMDR\u003c/span\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e-TB (RE)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 25 (1/4)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 29.3\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.5-589.8\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.001\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eMDR\u003c/span\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e-TB (N+RE)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eMonoresistant \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e┴┴ \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eRifampicin\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0\u003csup\u003e╪\u003c/sup\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.5\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0-6.6\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.000\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eIsoniazid\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0\u003csup\u003e╪\u003c/sup\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.5\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0-6.6\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.000\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eEthambutol\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 2.3\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eStreptomycin\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 3\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 3.4\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.5\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.2-13.0 \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.684\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eDouble resistant \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e┴┴ \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003csup\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eRifampicin + Streptomycin\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eIsoniazid + Streptomycin\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 5\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 5.6\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 5.2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.7-125.9\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.120\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eTriple resistant \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e┴┴ \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eRifampicin + Isoniazid + Streptomycin\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.0\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0-39.4 \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.000\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eIsoniazid + Ethambutol +Streptomycin\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eMonoresistant \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e┴┴ \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e5\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 5.7\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eDouble resistant \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e┴┴ \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e6\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 6.7\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.3-4.5\u003csup\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/sup\u003e0.768\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eTriple resistant \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e┴┴ \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 2.2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.4\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.1-2.0\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.281\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Rifampicin resistance\u003cstrong\u003e*\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 2.2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.3\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.0-1.3\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.101\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Isoniazid resistance\u003cstrong\u003e*\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 7\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 7.9\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Reference \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Ethambutol resistance\u003cstrong\u003e*\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 3\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 3.4\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.4\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.1-1.6\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.215\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003eAny Streptomycin resistance\u003cstrong\u003e*\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 11\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 12.4\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 1.6\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.6-4.7\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 0.335\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 9.0pt;\"\u003e*=Resistance to drug in question, either alone or in combination with resistance to others; N=New cases; RE=Re-treatment cases; \u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 9.0pt;\"\u003e┴┴= Resistance to the specified drug; MDR-TB= Multidrug resistant tuberculosis; OR=odds ratio; CI= confidence interval.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 9.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size: 9.0pt;\"\u003e╪ = calculated by adding 0.5 to numerator and denominator (reference).\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"line-height: 200%;\"\u003e\u003cstrong\u003e\u003cspan style=\"color: red;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Drug resistance, M. tuberculosis complex, antimicrobial susceptibility, Abuja, sputum, first-line drugs","lastPublishedDoi":"10.21203/rs.2.9513/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.9513/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: This study evaluated the prevalence of drug resistant tuberculosis infection among suspected tuberculosis patients attending Asokoro District Hospital (ADH), Abuja, Nigeria. Methods: A total of 301 AFB+/- sputum specimens from suspected TB patients were collected for the study following study approval from Asokoro District Hospital Ethic Committee. Eighty-nine (89) identified Mycobacterium tuberculosis complex were isolated after morphological and biochemical testing. Sputum specimens collected from the patients were processed, cultured on Lowenstein-Jensen (LJ) media and subjected to in-vitro antimicrobial susceptibility testing. The eighty-nine (89) identified M. tuberculosis complex isolates were challenged with Rifampicin (RIF), Isoniazid (INH), Ethambutol (EMB) and Streptomycin (SM) drugs respectively. Results: Out of the total 89 samples analyzed, 13 (14.6%) showed resistance to the first-line drugs while 76 (85.4%) were susceptible. Drug resistance was identified in 10 (11.8%) of the new tuberculosis case (primary drug resistance cases) and 3 (75%) in re-treatment cases (secondary or acquired resistance). Prevalence of mono-resistant, double resistant and triple resistant patterns were 5 (5.7%), 6 (6.7%) and 2 (2.2%) respectively. Multi-drug resistant (resistant to both RIF and INH, the two most potent anti-tuberculosis drugs, with or without resistant to other drugs) was 1.1%. No isolate was resistant to all the four drugs. Conclusion: Drug resistance were observed in the cultures of M. tuberculosis complex, however no isolate showed resistance to all the four first-line drugs used. This study therefore recommends strict adherent to medication for tuberculosis patients as poor compliance or inappropriate use of drugs could induce resistance.\nKeywords: Drug resistance, M. tuberculosis complex, antimicrobial susceptibility, Abuja, sputum, first-line drugs.","manuscriptTitle":"Evaluation of Drug Resistance from Sputum Specimens of Suspected Tuberculosis Patients attending a District Hospital, Abuja","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2019-05-07 21:20:23","doi":"10.21203/rs.2.9513/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48f5f075-44b2-4f94-b921-2cddfcbba284","owner":[],"postedDate":"May 7th, 2019","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":11932,"name":"General Microbiology"}],"tags":[],"updatedAt":"","versionOfRecord":[],"versionCreatedAt":"2019-05-07 21:20:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-820","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-820","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}