Childhood drug‐resistant tuberculosis in the Western Cape Province of South Africa

Abstract

Abstract Aim: Continued surveillance of drug resistance amongst children presenting with culture‐confirmed tuberculosis to a tertiary care hospital and to community clinics. Methods: Drug susceptibility testing for isoniazid and rifampicin was prospectively done on all children presenting with culture‐confirmed tuberculosis from three study populations: children diagnosed at Tygerberg Children's Hospital in the Western Cape Province, South Africa, between March 2003 and February 2005 (recent survey, hospital‐based group), and August 1994 and April 1998 (previous hospital‐based survey), and a community‐based group from five clinics during the recent survey. Results: Isoniazid resistance increased significantly from 6.9% (21/306 children) in the previous survey to 12.8% (40/313 children) in the recent survey (odds ratio (OR) 1.99, 95% confidence interval (CI) 1.11–3.59). Resistance to isoniazid and rifampicin (multidrug resistance) did not increase significantly between the surveys (7/306 in previous survey vs 17/313 in recent survey; OR 2.45, 95% CI 0.94–6.62). All resistance (isoniazid and/or rifampicin) was 18/127 (14.2%) in the community‐based group compared to 23/192 (12.0%) in the hospital‐based group (OR 0.82, 95% CI 0.41–1.68). Conclusion: The prevalence of drug‐resistant tuberculosis in this setting is increasing, reflecting ongoing transmission of drug‐resistant Mycobacterium tuberculosis.