Pola resistensi Mycobacterium Tuberculosis terhadap obat anti tuberkulosis di Kabupaten Donggala Sulawesi Tengah

NURHAYATI, Dra. Ning Rintiswati, M.Kes

2004 | Tesis | S2 Ilmu Kesehatan Masyarakat

Penyakit tuberkulosis merupakan problem kesehatan nasional dan kesehatan dunia. Salah satu masalah dalam pengobatan adalah resistensi terhadap Obat Anti Tuberkulosis (OAT). Sekitar 50 juta orang kemungkinan telah terinfeksi oleh M. tuberculosis yang resisten terhadap OAT khususnya rifampisin dan isoniasid serta kemungkinan terhadap OAT lainnya. Penelitian di Indonesia mengenai resistensi M. tuberculosis belum menjangkau seluruh daerah diantaranya di Kabupaten Donggala Provinsi Sulawesi Tengah. Dari data program P2TB paru dalam 5 tahun (1996-2000), gagal pengobatan 31 penderita, putus berobat 81 penderita, angka kesembuhan 67,7%. Hal ini menunjukkan bahwa pelaksanaan DOST belum terlaksana dengan baik serta didukung oleh keadaan geografis Kabupaten Donggala dimana antara satu desa dengan ibu kota kecamatan dipisahkan oleh gunung. Penelitian ini bertujuan untuk mengetahui pola resistensi M. tuberculosis resistensi terhadap OAT di Kabupaten Donggala Jenis penelitian observasional rancangan penelitian cross sectional study. Subyek penelitian berupa sputum pagi hari penderita dengan BTA positif. Data diperoleh dengan melakukan kultur menggunakan daftar chek list dan kuesioner. Waktu penelitian dilakukan dari bulanApril 2001 – Mei 2002. Hasil dianalisis dengan menggunakan perangkat lunak komputer program Epi info Versi 6,03 dan SPSS. Dari 61 isolat yang diperiksa 20 (32,8%) isolat yang sensitif semua obat dan 41 (67,1%) isolat yang resisten terhadap satu jenis obat atau lebih. Frekwensi M. tuberculosis terhadap OAT tertinggi terhadap resisten dua jenis obat dan terendah terhadap tiga jenis obat. Prosentase resisten menurut jenis obat tertinggi terhadap rifampisin dan terendah terhadap INH. Tidak tampak adanya pengaruh pencapaian program dengan kejadian resisten. Berdasarkan kesimpulan tersebut di atas perlunya penelitian lebih lanjut mengenai resisten primer dan resisten sekunder dan perlunya pengawasan obat anti tuberkulosis bebas.

Tuberculosis has still been one of national health problem and global health. One of problem in its tratment was the resistance toward Anti Tuberculosis Medicine (OAT). Approximately 50 millions people were infected by M. tuberculosis and they were resistant toward OATs particularly, rifampicin, and isoniazid, also probably other drugs. Domestic research on the resistance of M. tuberculosis had not embraced all regions, such as Donggala regency, Central Sulawesi propince. Data of P2TB program on lungs during five years (1996-2000) showed that 31 patient were unsuccessfully treated, 81 patiens stopped their treatment and 67,7% patients recovered. This indicated that DOTS had not been will implemented and it was supported by geographical setting of Donggala regency, where villages are split from their capital sub-district by a mount. The present research was aimed to identify the pattern of M. tuberculosis resistance on OAT in Donggala regency related to the success rate of program in preventing tuberculosis using DOTS strategy. It was an observational research with cross-sectional study design. Subjects involved morning sputa of patients with positive BTA. Data were obtained by developing cultures through the use of check list. The research was conducted from April 2001 to May 2002. Results were analyzed using Epi info version 6,03 and SPSS programs. It was concluded that of 61 isolates examined, 20 (32,8%) and 41(67,2%) were resistant toward all medicines ang one medicine or more, respectively. The highest and lowest frequencies of M. Tuberculosis were found to be resistant toward two and three types of OATs, respectively. The highest and the lowest presentages of resistance by types of medicine were detected on rifampisin and INH, respectively. No effect of program achievement was shown to influence incidences of resistance. Based on the aforementioned conclusion, performing further research on primary and secondary resistance and monitoring free-traded anti tuberculosis medicines are still required.

Kata Kunci : Epidemiologi Lapangan,Obat Anti TBC,Resistensi Mycobacterium TB,M. tuberculosis, resistance on OAT, program achievement, Donggala regency