Drug-resistant tuberculosis pattern in Indonesia: a systematic review

Background: One of the most pressing and challenging issues facing global tuberculosis ( TB) control is the ongoing spread of drug-resistant tuberculosis. Patients with multidrug-resistant (MDR) TB, or forms of the disease resistant to isoniazid and rifampicin, are essentially incurable by first-line conventional therapy. This systematic review aims to address Indonesia's specific patterns of drug-resistant tuberculosis. Methods: We examined 178 articles and selected eight studies that met DR-TB criteria in Indonesia, analyzing 1,415 patients. Systematic review conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Results: We found mono-resistant (403, 28.5%), poly-resistant (362, 25.6%), multi-drug resistant (MDR) (571, 40.4%), pre-extensively drug-resistant (pre-XDR) (47, 3.3%), and XDR (32, 2.3%) cases. Among these, 758 DR-TB cases were analyzed, with the most common resistances being to rifampicin (706, 93.1%), isoniazid (325, 42.9%), ethambutol (95, 12.5%), streptomycin (79, 10.4%), kanamycin (7, 0.9%), amikacin (7, 0.9%), pyrazinamide (2, 0.3%), capreomycin (1, 0.1%), levofloxacin (1, 0.1%), and moxifloxacin (1, 0.1%). There was no data on bedaquiline or delamanid resistance. Conclusion: These findings highlight the concerning prevalence of pre-XDR and XDR TB cases in Indonesia, even amidst the challenges posed by first-line drug resistance in DR-TB cases.