Pattern of Drug Resistance Among Patients Presenting with Relapse of Pulmonary Tuberculosis


  • Muhammad Hammad Department of Medicine, Pak Emirates Military Hospital, Rawalpindi/ National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Sharjeel Mayo Hospital Lahore
  • Imran Fazal Department of Medicine, Pak Emirates Military Hospital, Rawalpindi/ National University of Medical Sciences (NUMS) Pakistan
  • Amna Aziz Department of Haematology, Armed Forces Institute of Pathology/ National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Farhan Shahid Department of Medicine, Pak Emirates Military Hospital, Rawalpindi/ National University of Medical Sciences (NUMS) Pakistan
  • Mahmood Iqbal Department of Medicine, Pak Emirates Military Hospital, Rawalpindi/ National University of Medical Sciences (NUMS) Pakistan



Antitubercular Agents, Drug Resistance, Drug Susceptibility Testing, Extensively Drug-resistant Tuberculosis, Multidrug-resistant Tuberculosis


Objective: To assess the patterns of drug resistance (DR) among patients previously treated for pulmonary tuberculosis (TB).

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Medicine, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2020 to Mar 2021.

Methodology: Patients with previously treated pulmonary TB were included, based on their clinical history and characteristic chest X-ray findings. Patients were evaluated through an examination of sputum and/or bronchoalveolar washings for acidfast bacilli (AFB), Mycobacterium TB-GeneXpert/RIF (Rifampicin) assay, and mycobacterial culture with drug susceptibility testing (DST). Patients with resistance to any anti-TB drug were classified as cases of DR-TB, and a pattern of drug resistance was documented.
Results: One hundred twenty patients were identified as having been previously treated for TB. DST demonstrated DR-TB among 38(31.7%) cases, while isoniazid (INH) resistance was the most commonly reported problem in 29(24.2%) cases. Up to 26(21.6%) relapsing cases were resistant to Rifampicin (RFM). Moreover, 15(12.5%) instances of resistance against second-line anti-TB drugs (fluoroquinolones and aminoglycosides) were documented. Multidrug-resistant TB (MDR-TB) was the most prevalent resistance pattern in 20(16.7%) cases, followed by mono-drug-resistant TB in 7(5.8%) and extensively resistant TB (XDR-TB) in 2(1.6%) cases. No definitive resistance pattern was evident among 9(7.5%) cases.

Conclusion: MDR-TB constitutes a major barrier in the line of TB eradication in Pakistan. Strict compliance with anti-TB protocols, along with a universal application of DST, can minimize the overall prevalence of relapsing cases of TB


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Banu S, Rahman MT, Ahmed S, Khatun R, Ferdous SS, Hosen B,

et al. Multidrug-resistant tuberculosis in Bangladesh: results

from a sentinel surveillance system. Int J Tuberc Lung Dis 2017;

(1): 12-17.

Saldanha, N., Runwal, K., Ghanekar, C. High prevalence of

multi drug resistant tuberculosis in people living with HIV in

Western India. BMC Infect Dis 2019; 19: 391.

Akhtar AM, Arif MA, Kanwal S, Majeed S. Prevalence and drug

resistance pattern of MDR TB in retreatment cases of Punjab,

Pakistan. J Pak Med Assoc 2016(8): 989-993.

Ali S, Khan MT, Khan AS, Mohammad N, Khan MM, Ahmad S,

et al. Prevalence of Multi-Drug Resistant Mycobacterium

tuberculosis in Khyber Pakhtunkhwa - A High Tuberculosis

Endemic Area of Pakistan. Pol J Microbiol 2020; 69(2): 1–5.

Mandatory notification of Tuberculosis Patients. [Internet]. 2020.

Available at: [Accessed on November 12, 2020].

Faustini A, Hall AJ, Perucci CA. Risk factors for multidrug

resistant tuberculosis in Europe: a systematic review. Thorax


Jamal Y, Jamal A, Ali A, Malik M, Kamran S, Alamgir W. et al.

Resistance patterns in patients of drug resistant pulmonary

tuberculosis. Pak Armed Forces Med J 2019; 69(5): 1077-1082.

Shah NS, Wright A, Bai GH, Barrera L, Boulahbal F, MartínCasabona N, et al. Worldwide emergence of extensively drugresistant tuberculosis. Emerg Infect Dis 2007; 13(3): 380-387.

Sharma SK, Kumar S, Saha PK, George N, Arora SK, Gupta D, et

al. Prevalence of multidrug-resistant tuberculosis among

category II pulmonary tuberculosis patients. Indian J Med Res

; 133(3): 312-315.

Shao Y, Yang D, Xu W, Lu W, Song H, Dai Y, et al.

Epidemiology of anti-tuberculosis drug resistance in a chinese

population: current situation and challenges ahead. BMC Public

Health 2011; 11(1): 110.

Hasan R, Jabeen K, Mehraj V, Zafar F, Malik F, Hassan Q, et al.

Trends in Mycobacterium tuberculosis resistance, Pakistan,

-2007. Int J Infect Dis 2009; 13(6): e377-382.

He GX, Zhao YL, Jiang GL, Liu YH, Xia H, Wang SF, et al.

Prevalence of tuberculosis drug resistance in 10 provinces of

China. BMC Infect Dis 2008; 8(1): 166.

Gegia M, Winters N, Benedetti A, van Soolingen D, Menzies D.

Treatment of isoniazid-resistant tuberculosis with first-line

drugs: a systematic review and meta-analysis. Lancet Infect Dis

; 17(2): 223-234.

Jenkins HE, Zignol M, Cohen T. Quantifying the burden and

trends of isoniazid resistant tuberculosis, 1994-2009. PloS One

; 6(7): e22927.

Eker B, Ortmann J, Migliori GB, Sotgiu G, Muetterlein R, Centis

R, et al. Multidrug- and extensively drug-resistant tuberculosis,

Germany. Emerg Infect Dis 2008; 14(11): 1700–1706.

Zhang Z, Lu J, Wang Y, Pang Y, Zhao Y. Prevalence and

molecular characterization of fluoroquinolone-resistant

Mycobacterium tuberculosis isolates in China. Antimicrob

Agents Chemother 2014; 58(1): 364-349.

Agrawal D, Udwadia ZF, Rodriguez C, Mehta A. Increasing

incidence of fluoroquinolone-resistant Mycobacterium tuberculosis in Mumbai, India. Int J Tuberc Lung Dis 2009; 13(1): 79-83.

Long R, Chong H, Hoeppner V, Shanmuganathan H,

Kowalewska-Grochowska K, Shandro C, et al. Empirical

Treatment of Community-Acquired Pneumonia and the

Development of Fluoroquinolone-Resistant Tuberculosis. Clin

Infect Dis 2009; 48(10): 1354-1360.

Gao JT, Xie L, Ma LP, Shu W, Zhang LJ, Ning YJ, et al.

Prolonged use of bedaquiline in two patients with pulmonary

extensively drug-resistant tuberculosis: Two case reports. World

J Clin Cases 2021; 9(10): 2326-2333.

Matteelli A, Roggi A, Carvalho AC. Extensively drug-resistant

tuberculosis: epidemiology and management. Clin Epidemiol

; 6: 111-118.




How to Cite

Hammad M, Muhammad Sharjeel, Imran Fazal, Amna Aziz, Farhan Shahid, Mahmood Iqbal. Pattern of Drug Resistance Among Patients Presenting with Relapse of Pulmonary Tuberculosis. Pak Armed Forces Med J [Internet]. 2024 Apr. 29 [cited 2024 May 24];74(2):362-6. Available from:



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