Surveillance of antituberculosis drug resistance among children from the Western Cape Province of South Africa--an upward trend

Am J Public Health. 2009 Aug;99(8):1486-90. doi: 10.2105/AJPH.2008.143271. Epub 2009 Feb 5.


Objectives: We assessed the prevalence of antituberculosis drug resistance among children with tuberculosis (TB) in the Western Cape Province of South Africa.

Methods: Drug susceptibility testing for isoniazid and rifampin was prospectively done on all children with culture-confirmed TB at Tygerberg Children's Hospital, Cape Town, from March 2005 through February 2007. Survey results were compared with results from 2 previous surveys.

Results: We found 291 children had culture-confirmed TB. Resistance to isoniazid or rifampin increased from 21 of 306 (6.9%) to 41 of 319 (12.9%) and 43 of 285 (15.1%) in the first to third surveys (P = .005) and multidrug resistance from 7 of 306 (2.3%) to 18 of 319 (5.6%) and 19 of 285 (6.7%; P = .033). Although previously treated children had significantly more drug resistance than did new TB cases (19 of 66 [28.8%] vs 24 of 225 [10.7%]; odds ratio = 3.39; 95% confidence interval = 1.62, 7.05), evidence suggests transmission rather than acquisition of resistance. HIV infection was not significantly associated with drug resistance.

Conclusions: Results indicate a high and rising prevalence of anti-TB drug resistance among children in the Western Cape, which suggests ongoing transmission of drug-resistant strains within the community. Improved control of TB in adults, including early identification and treatment of drug-resistant cases, is necessary to reduce transmission to children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Catchment Area, Health
  • Child
  • Drug Resistance, Microbial*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • HIV Seropositivity / epidemiology
  • Humans
  • Male
  • Prevalence
  • South Africa / epidemiology
  • Surveys and Questionnaires*
  • Tuberculosis, Pulmonary / drug therapy*
  • Tuberculosis, Pulmonary / epidemiology*