RESUMO
SETTING: A hospital-based study at the Makati Medical Center, Makati City, Philippines, a hyperendemic area for tuberculosis (TB). OBJECTIVE: To determine the susceptibility of Mycobacterium tuberculosis to ciprofloxacin and ofloxacin. DESIGN: Retrospective analysis of drug susceptibility tests (DST) of M. tuberculosis isolated from 1995-2000. RESULTS: Resistance to ciprofloxacin was 26.8%, ofloxacin 35.3%, and multidrug resistance (MDR) was 17.2%. Of the MDR strains, 51.4% were resistant to ciprofloxacin and ofloxacin. Acquired resistance was significantly higher for all first-line drugs and for ciprofloxacin, but not for ofloxacin. A significant increase in resistance to ciprofloxacin and ofloxacin was noted compared to 1989-1994, while resistance to the firstline drugs was not significantly different. CONCLUSION: Ciprofloxacin and ofloxacin are now a significantly less effective alternative therapy in tuberculosis, particularly MDR-TB, due to a selection pressure from their widespread use in the treatment of TB and possibly other infections in the community, which is hyperendemic for tuberculosis.
Assuntos
Anti-Infecciosos/farmacologia , Ciprofloxacina/farmacocinética , Resistência a Múltiplos Medicamentos , Hospitais , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Ofloxacino/farmacocinética , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Meios de Cultura , Resistência Microbiana a Medicamentos , Humanos , Técnicas In Vitro , Testes de Sensibilidade Microbiana , Ofloxacino/uso terapêutico , Filipinas , Estudos Retrospectivos , Escarro/microbiologiaAssuntos
Antituberculosos/farmacologia , Resistência a Múltiplos Medicamentos , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Antituberculosos/uso terapêutico , Etambutol/administração & dosagem , Feminino , Humanos , Incidência , Isoniazida/administração & dosagem , Masculino , Testes de Sensibilidade Microbiana , Filipinas/epidemiologia , Pirazinamida/administração & dosagem , Rifampina/administração & dosagem , Tuberculose Resistente a Múltiplos Medicamentos/diagnósticoRESUMO
SETTING: Clinical microbiology laboratory with limited resources in a developing country. OBJECTIVE: To determine the recovery rate of Mycobacterium tuberculosis (MTB) in Mycobacteria Growth Indicator Tube (MGIT) combined with Löwenstein Jensen (LJ) culture medium. DESIGN: Stock cultures and reference strains of mycobacteria and clinical specimens were inoculated into MGIT and onto LJ. The combined recovery rate was determined and time to positive culture in each medium was compared. RESULTS: All known stock and reference cultures of mycobacteria grew in both media. MGIT combined with LJ increased the recovery rate from 109 (63.4%) to 122 (70.9%) of 172 clinical specimens. Of those isolated, the yield in MGIT (99.2%) exceeded that in LJ (89.3%). The average day to detection of MTB in MGIT was earlier by 14.2 days compared to LJ (15.7 days vs. 29.9 days). For mycobacteria other than tuberculosis (MOTT), there was little difference in the recovery time, except for M. kansasii where growth in MGIT was earlier by one week and M. triviale where growth in MGIT was detected later than LJ. CONCLUSION: MGIT is an excellent system for the rapid isolation of mycobacteria. It increases the recovery rate of MTB when combined with LJ.
