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Wednesday 24 August 2016
Population-based resistance of Mycobacterium tuberculosis isolates to pyrazinamide and fluoroquinolones

After the summer holidays, WAidid is back to talk about tuberculosis, through an article published in The Lancet Infectious Diseases and available online from 07 July 2016. The review is about the extent of resistance to Pyrazinamide and fluoroquinolones, that are essential antituberculosis drugs.

This study presents the results of the first population-based surveys investigating levels of resistance to pyrazinamide, ofloxacin, levofloxacin, moxifloxacin, and gatifl oxacin among patients with tuberculosis in countries with high burden of tuberculosis and multidrug-resistant tuberculosis. In routine surveillance and patient management, testing for resistance to these drugs is restricted to certain patient groups, such as those with rifampicin resistance or a history of previous treatment for tuberculosis. This dataset therefore provides essential insight into the background proportions of resistance to these drugs at population level and in particular among newly diagnosed tuberculosis cases. This work offers insight into the feasibility of introducing new tuberculosis treatment regimens and strategies for drug-susceptibility testing in these settings.
Although pyrazinamide resistance was significantly associated with rifampicin resistance, this drug may still be effective in 19–63% of patients with rifampicin-resistant tuberculosis. Even though the high level of resistance to ofloxacin found in Pakistan is worrisome because it might be the expression of extensive and unregulated use of fluoroquinolones in some parts of Asia, the negligible levels of resistance to fourth-generation fluoroquinolones documented in all sites involved in the study is an encouraging finding. Rational use of this class of antibiotics should therefore be ensured to preserve its effectiveness.

AUTHORS: Matteo Zignol, Anna S Dean, Natavan Alikhanova, Sönke Andres, Andrea Maurizio Cabibbe, Daniela Maria Cirillo, Andrei Dadu, Andries Dreyer, Michèle Driesen, Christopher GilpinRumina Hasan, Zahra Hasan, Sven Hoffner, Ashaque Husain, Alamdar Hussain, Nazir Ismail, Mostofa Kamal, Mikael Mansjö, Lindiwe Mvusi, Stefan Niemann, Shaheed V Omar, Ejaz Qadeer, Leen Rigouts, Sabine Ruesch-Gerdes, Marco Schito, Mehriban Seyfaddinova, Alena Skrahina, Sabira Tahseen, William A Wells, Ya Diul Mukadi, Michael Kimerling, Katherine Floyd, Karin Weyer, Mario C Raviglione

To read the article online click HERE