Anti-tuberculosis drug resistance in two clinics in Ecuador

SETTING: Two private hospitals, one in the capital city and one in the east ern rainforest of Ecuador. OBJECTIVE: To document the prevalence of anti-tuberculosis drug resistance in Ecuador in patients who had not received prior treatment and in those wh o had. DESIGN: Drug resistance was determined using the proportion method with sol id medium on the first isolate of Mycobacterium tuberculosis from all patie nts who attended the two hospitals between 1989 and 1996. Documentation of prior treatment was obtained by patient interview RESULTS: Resistance was identified in 33 of 161 patients (24%) who had had no prior treatment. Resistance was 14.2% to isoniazid, 11.8% to rifampin an d 8.7% to both (multidrug-resistant tuberculosis). Among GO patients who ha d received prior treatment, 18 (30%) were resistant to isoniazid, and 14 (2 3.3%) to rifampin, while multidrug resistance was seen in 10 (16.7%). CONCLUSION: In these populations the prevalence of resistance both in patie nts with no prior treatment and in patients with prior treatment was ominou sly high. The initial treatment regimens and patient management in Ecuador should be re-evaluated in an effort to prevent further increases in drug re sistance.