Resistance to first-line tuberculosis drugs in three cities of Nigeria

Objectives To determine the levels of resistance to first-line tuberculosis drugs in three cities in three geopolitical zones in Nigeria. Methods A total of 527 smear-positive sputum samples from Abuja, Ibadan and Nnewi were cultured on BACTEC- MGIT 960. Drug susceptibility tests (DST) for streptomycin, isoniazid, rifampicin and ethambutol were performed on 428 culture-positive samples on BACTEC-MGIT960. Results Eight per cent of the specimens cultured were multi-drug-resistant Mycobacterium tuberculosis (MDR-TB) with varying levels of resistance to individual and multiple first-line drugs. MDR was strongly associated with previous treatment: 5% of new and 19% of previously treated patients had MDR-TB (OR 4.1 (95% CI 1.9-8.8), P=0.001) and with young adult age: 63% of patients with and 38% without MDR-TB were 25-34years old (P=0.01). HIV status was documented in 71%. There was no association between MDR-TB and HIV coinfection (P=0.9) and gender (P>0.2 for both). Conclusions MDR-TB is an emerging problem in Nigeria. Developing good quality drug susceptibility test facilities, routine monitoring of drug susceptibility and improved health systems for the delivery of and adherence to first- and second-line treatment are imperative to solve this problem.