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Research article - Peer-reviewed, 2023

First and Second-Line Anti-Tuberculosis Drug-Resistance Patterns in Pulmonary Tuberculosis Patients in Zambia

Monde, Ngula; Munyeme, Musso; Chongwe, Gershom; Wensman, Jonas Johansson; Zulu, Mildred; Siziya, Seter; Tembo, Rabecca; Siame, Kabengele K. K.; Shambaba, Obi; Malama, Sydney


Background: Drug-resistant tuberculosis has continued to be a serious global health threat defined by complexity as well as higher morbidity and mortality wherever it occurs, Zambia included. However, the paucity of information on drug-susceptibility patterns of both first-line and second-line anti-tuberculosis (anti-TB) drugs, including the new and repurposed drugs used in the management of drug-resistant tuberculosis in Zambia, was the major thrust for conducting this study. Methods: A total of 132 bacteriologically confirmed TB isolates were collected from patients with pulmonary TB during the period from April 2020 to December 2021 in Southern and Eastern Provinces of Zambia. Drug-resistance profiles were determined according to four first-line and five second-line anti-TB drugs. Standard mycobacteriological methods were used to isolate and determine phenotypic drug susceptibility. Data on the participants' social-demographic characteristics were obtained using a pre-test checklist. Results: Overall, the prevalence of resistance to one or more anti-TB drugs was 23.5% (31/132, 95% CI: 16.5-31.6%). A total of 9.8% (13/132, 95% CI: 5.3-16.2%) of the patients had multidrug-resistant TB and 1.2% were new cases, while 25.5% had a history of being previously treated for TB. Among those with mono-resistant TB strains, isoniazid (INH) resistance was the highest at 9.8% (13/132, 95% CI: 5.3-16.2%). Two (2/31) (6.5%) XDR-TB and one (1/31) (3.2%) pre-XDR-TB cases were identified among the MDR-TB patients. Previously treated patients were 40 times more likely (OR; 40.3, 95% CI: 11.1-146.5%) to have drug-resistant TB than those who had no history of being treated for TB. Conclusion: This study has established a high rate of multidrug-resistant TB and has further identified both pre-XDR- and XDR-TB. There is a need to intensify surveillance of MDR- and XDR-TB to inform future guidelines for effective treatment and monitoring.


drug resistance; extensively drug-resistant; multidrug; tuberculosis; second-line drugs

Published in

2023, volume: 12, number: 1, article number: 166
Publisher: MDPI

Authors' information

Monde, Ngula
University of Zambia
Munyeme, Musso
University of Zambia
Chongwe, Gershom
Tropical Diseases Research Center
Wensman, Jonas Johansson (Johansson Wensman, Jonas)
Swedish University of Agricultural Sciences, Department of Clinical Sciences
Wensman, Jonas Johansson (Johansson Wensman, Jonas)
National Veterinary Institute SVA
Zulu, Mildred
University of Zambia
Siziya, Seter
Copperbelt University
Tembo, Rabecca
University of Zambia
Siame, Kabengele K.
Tropical Diseases Research Center
Shambaba, Obi
University of Zambia
Malama, Sydney
University of Zambia

Sustainable Development Goals

SDG3 Good health and well-being

UKÄ Subject classification

Infectious Medicine

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