Standardization of antituberculosis drug resistance surveillance in Europe- Recommendations of a World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD) Working Group

Surveillance of antituberculosis drug resistance is an essential tool for e valuating the quality of tuberculosis control programmes. Consensus-based r ecommendations on uniform reporting of antituberculosis drug resistance sur veillance data in Europe have been developed by a Working Group of the Worl d Health Organization (WHO) and the International Union Against Tuberculosi s and Lung Disease (IUATLD). Laboratories should use standardized methods for testing drug susceptibilit y with a quality assurance programme including national and international p roficiency testing. The proportion of drug resistance, particularly resista nce to isoniazid, rifampicin or both (multidrug resistance) among all defin ite, i.e., culture-positive, tuberculosis eases at the start of treatment i s the major indicator of interest. It should be calculated separately among patients treated previously and among those who have never been treated wi th greater than or equal to 1 month of combined antituberculosis drugs. The Working Group recommends that, in countries in which resources allow, l aboratories report drug susceptibility test results on all isolates of the Mycobacterium tuberculosis complex. Test results of the specimen at the sta rt of treatment and clinical data from the notification should be Linked us ing a suitable identifier. Results should be presented by calendar year and analysed by age, sex, place of birth, site of disease and sputum smear res ults. In countries in which a routine system cannot be organized, representative surveys or sentinel systems are possible alternatives. In some countries, t he annual prevalence of multidrug-resistant tuberculosis may be estimated t hrough a national laboratory reporting system.