Primary drug-resistant tuberculosis in children

SETTING: The Western Cape Province of South Africa, an area with a high tub erculosis (TB) incidence where initial isoniazid (INH) resistance and multi drug resistance (MDR) among adults was 3.9% and 1.1%, respectively, during 1992-1993. OBJECTIVE: To determine the drug resistance incidence among children as com pared to adults, to compare the clinical features of drug-resistant and dru g-susceptible TB, and the degree of INH resistance in isoniazid-resistant i solates. METHODS: All Mycobacterium tuberculosis cultures obtained from children (0- 13 years) at a regional hospital were prospectively collected from August 1 994 to April 1998 and susceptibility testing done on each child's specimens . Degree of INH resistance was determined in available resistant isolates. The children's clinical records were reviewed. RESULTS: Susceptibility results were available in 306/ 338 children with cu ltures of M. tuberculosis; 21 isolates (6.9%) were INH-resistant, and seven were MDR. Taking into account study limitations, the incidence of INH resi stance was 5.6% and MDR 1% in children aged <5 years. Clinical features wer e similar in children with drug-susceptible and drug-resistant TB. CONCLUSION: The incidence of drug resistance in childhood tuberculosis in W estern Cape is low and probably reflects the level of primary drug resistan ce amongst organisms currently circulating in the community.