HIGH PROPORTION OF MULTIDRUG-RESISTANT MYCOBACTERIUM-TUBERCULOSIS IN SAUDI-ARABIA

289 patients with TB, presented to a single tertiary care unit in Saud i Arabia between 1989 and 1994. The isolate from each patient was test ed for in vitro susceptibility to rifampicin, isoniazid, ethambutol, p yrazinamide and streptomycin. 25 patients (8.7%) had isolates resistan t to at least 1 anti-tuberculous drug, Single drug resistance (SDR)-ma inly isoniazid-occurred in 14, and resistance to at least 2 drugs (mul ti-drug resistance-MDR) in 11, of which 8 were due to both isoniazid a nd rifampicin, Previous drug treatment occurred significantly more oft en in patients with MDR (8/11), than SDR (1/14) (p = 0.0021). A litera ture review of another 5571 patients from Saudi Arabia with TB reveale d an incidence of resistance of M. tuberculosis isolates to at least 1 anti-tuberculous, drug tested, of between 5.9% and 44%. The overall p ercentage of patients with resistant tuberculosis (including our own p atients) was 14.9%, Resistance to streptomycin (8.9%), isoniazid (6.6% ), and rifampicin (6.1%) mere the commonest reported. There were as ma ny patients with MDR as there mere SDR, A history of previous anti-tub erculous treatment was found in over 40%. The high rate of anti-tuberc ulous resistance in Saudi Arabia may be due to poor supervision of ant i-TB treatment, the embryonic healthcare system, over-the-counter anti biotic availability, treatment of endemic diseases such as brucella wi th rifampicin etc., a Large migrant work force, and possibly increased toxicity of anti-tuberculous drugs secondary to the high incidence of chronic liver disease in the country.