Epidemiology and Infection

Risk factors for drug resistant tuberculosis in Leicestershire – poor adherence to treatment remains an important cause of resistance

A. J. PRITCHARD a1c1, A. C. HAYWARD a2, P. N. MONK a3 and K. R. NEAL a4
a1 Bassetlaw Primary Care Trust, c/o Ransom Hall, Southwell Road West, Rainworth, Mansfield, Nottinghamshire, NG21 0ER
a2 Centre for Infectious Disease Epidemiology, University College London, Department of Primary Care and Population Sciences, Royal Free Hospital, Rowland Hill Street, London NW3 2PF
a3 Leicestershire, Northamptonshire and Rutland, Health Protection Team, Gwendolen Rd, Leicester LE5 4QF
a4 Division of Public Health Sciences, School of Community Health Sciences, University of Nottingham Medical School, Nottingham NG7 2UH

Article author query
pritchard a   [PubMed][Google Scholar] 
hayward a   [PubMed][Google Scholar] 
monk p   [PubMed][Google Scholar] 
neal k   [PubMed][Google Scholar] 


In the light of rising numbers of tuberculosis (TB) cases in the United Kingdom, the problem of anti-tubercular drug resistance remains a significant concern. Drug resistant TB cases are more difficult and costly to treat, and require appropriate treatment and control mechanisms. This matched case control study aimed to investigate risk factors for resistance in Leicestershire, using data for laboratory isolates of Mycobacterium tuberculosis identified from 1993 to 1998. Each case, defined as culture positive laboratory isolates resistant to at least one first-line drug, was matched to four fully sensitive controls on age, sex and ethnic group. Twenty-three cases and 81 controls were included in the analysis. Drug resistance in Leicestershire was found to be associated with poor adherence to treatment (OR 4·8, 95% CI 1·6–14·4, P=0·005) and with previous TB (OR 3·7, 95% CI 1·2–11·8, P=0·022). These findings emphasize the need to provide support to patients taking treatment in order to maximize adherence.

(Accepted January 6 2003)

c1 Author for correspondence.