Drug resistance in South Africa

Resistance to anti-tuberculosis agents is an important factor in the ability of a national programme to manage tuberculosis. In South Africa data from new

FIG. 3. The notified incidence of tuberculosis (TB) for individuals aged <6 years (•), 6—14 years (A) and > 14 years (O) in enumerator subdistricts of Ravensmead and Uitsig with a mean annual income classified as high (US$6240), medium—high (US$5352), medium (US$4826), medium—low (US$3615) and low (US$1763).

FIG. 3. The notified incidence of tuberculosis (TB) for individuals aged <6 years (•), 6—14 years (A) and > 14 years (O) in enumerator subdistricts of Ravensmead and Uitsig with a mean annual income classified as high (US$6240), medium—high (US$5352), medium (US$4826), medium—low (US$3615) and low (US$1763).

patients at sentinel hospitals have been collected for about 30 years. Primary and acquired isoniazid resistance declined from 14% and 54%, respectively, in 1965— 1970 to 9.5% and 15%, respectively, in 1987—1988 (Weyer & Kleeberg 1992). In the Western Cape a recent detailed analysis found initial and acquired isoniazid resistance rates of 3.9% and 10.8%, respectively, and multidrug resistance rates of 1.1% and 4.0%, respectively (Weyer et al 1995).

The dire consequences of multidrug-resistant tuberculosis are highlighted by our experience of following up 443 multidrug-resistant tuberculosis patients five years after diagnosis (Schaaf et al 1996). Amongst those with isoniazid and rifampicin resistance mortality was 48%, compared to 27% in those resistant to either isoniazid or rifampicin and other drugs. Only 33% of patients were cured after five years, 15% were respiratory cripples and 13% remained bacterio-logically positive.

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