National anti TB drug resistance Egypt

Multi drug Resistant Tuberculosis: 

Multi drug Resistant Tuberculosis National Tuberculosis Control Programme

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Multi drug Resistant Tuberculosis MDR-TB, defined as resistance to the two most important drugs, isoniazid (INH) and rifampicin (RMP), is a potential threat to tuberculosis control. Patients infected with strains resistant to multiple drugs are extremely difficult to cure, and the necessary treatment is much more toxic and expensive.

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Drug resistance survey, Egypt (Pilot phase March 2000) (Extension phase March 2001)

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Technical Steps At the Peripheral lab. 3 samples are taken from each patient. Prepare and examine 2 samples after straining with Z.N. The samples should be identified on the container as well as the cover and the code number of the patient is written on the containers. Code number: governorate/ Chest clinic /No. on the special register of the survey. 2 samples from each positive case are sent to the intermediate lab with the questionnaire and special request form for culture. Drug resistance survey, Egypt

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At the Intermediate lab. A Z.N film from each sputum sample is examined One of sample is kept in the refrigerator and the second one is treated for culture on Lowenstein Jensen media and stone brink media. Positive cultures are sent to the C.L in ice box with the questionnaire and request for sensitivity test. Drug resistance survey, Egypt

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At the Central Lab Questionnaire is checked for the previous items. All the samples are registered in the Lab. register serially. Identification of the isolate is done using niacin test by strips and catalase test. Sensitivity tests is done by proportional method External quality control, all resistant strains and percentage of sensitive strains (10-15%) are sent to the SRL. Drug resistance survey, Egypt

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WHO Recommended methodology Duration survey March 2000-July 2000 Sample site: Chest Clinics Cairo and Giza Validation patient category: questionnaire (before start treatment) Culture – Identification – Susceptibility Quality control with international reference lab Drug resistance survey, Egypt (Pilot phase March 2000)

Results – table -1-: 

Results – table -1-

Results – table -2-: 

Results – table -2-

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Drug resistance survey, Egypt (Extension phase March 2001) Aim This study aims at assessing the magnitude of Multi Drug Resistant(MDR) Problem as a step to put a strategy to overcome this problem

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Drug resistance survey, Egypt (Extension phase March 2001) Objectives: Identification of the prevalent resistant types of bacilli. Epidemiological features of MDR cases. To update the intermediate lab.Capabilities both equipment and personnel to be able to identify strains

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Drug resistance survey, Egypt (Extension phase March 2001) Methodology 18 governorates have been selected on basis of number of new smear +ve cases attending the clinics en each governorates(the number of attendants should not be les than 100 patients/year) It expected that the Central Lab.to handle 1500-1800 sensitivity tests during 12months of continuous work The first 100 new smear +ve case in each governorate will be enrolled in the study.

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Drug resistance survey, Egypt (Extension phase March 2001)

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New Cases Drug resistance survey, Egypt (Extension phase March 2001) Old Cases

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Total Number Tested 389 Total Sensitivity 286= 73.5% Resistance to one drug New Cases

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New Cases Multiple drug Resistance

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Total Number Tested 149 Total Sensitivity 41= 27.5% Resistance to one drug Chronic Cases

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Old Cases Multiple drug Resistance