Low rifampicin and early signs of next-line drug resistances: findings from Madagascar’s 2023–24 nationwide drug resistance survey
Abstract
Madagascar’s first national drug-resistance survey (2005-06) reported multidrug-resistant tuberculosis (MDR-TB) in 0.2% of new and 3.4% of retreatment patients. To generate updated resistance estimates, a national cross-sectional, cluster-randomised survey was conducted across 36 diagnostic and treatment centres between April 2023 and April 2024. Bacteriologically confirmed pulmonary TB patients were enrolled and sputum specimens collected for drug-resistance testing, including culture, line-probe assay, Xpert MTB/RIF Ultra, and phenotypic drug-susceptibility testing. Of 2,250 enrolled patients, 1,987 were new (88.3%) and 263 were previously treated (11.7%). Weighted prevalence of rifampicin resistance was 0.2% (95% CI 0.1–0.7%) among new patients and 3.7% (95% CI 1.7–7.8%) among previously treated patients, reflecting stability since the 2005-06 survey. No pre-XDR or XDR-TB was detected. However, resistance to bedaquiline or linezolid was found in 2 of 40 new patients and 2 of 11 retreatment patients among rifampicin- and/or isoniazid-resistant isolates. Overall, the findings indicate a stable and contained RR-TB burden in Madagascar. Sustaining this outcome will require continued investment in case detection, drug-susceptibility testing, effective treatment, and routine resistance surveillance.
Related
- Rapid detection of non-rifampicin resistant drug-resistant tuberculosis using Xpert MTB/XDR testing: Findings from a multisite drug-resistant tuberculosis case detection surge in Zambia
- Emergence and characterisation of bedaquiline, pretomanid and linezolid resistance in recurrent rifampicin-resistant tuberculosis patient: A case report
- Rifabutin Cross-resistance and Associated rpoB Mutations in Rifampicin-resistant Mycobacterium tuberculosis Complex Isolates
- Probe-level performance of Xpert MTB/RIF versus phenotypic culture for rifampicin resistance detection and a triage algorithm based on 3,360 clinical specimens in China.
- Atopic Dermatitis and Probiotic Use in Children Aged 1–4 Years: Findings from a Nationwide Survey in Serbia
BibTeX
@article{ratovoson2026rifampicin,
title = {{Low rifampicin and early signs of next-line drug resistances: findings from Madagascar’s 2023–24 nationwide drug resistance survey}},
author = {Rila Ratovoson and Astrid M. Knoblauch and Simon Grandjean Lapierre and Holy N. Andriamamonjisoa and Rado C. Rasoloarisata and Rojovola Randrianarivony and Mamy Serge Raherison and Henry Byabajungu and Hary Seheno Andriambololona and Andrianantenaina Rakotoson and Tojosoa Daniel Ramananjanahary and Rindra Randremanana and Daniella Randriamanana and Richard Mbumba Ngimbi and Eveline Klinkenberg and Michel Tiaray Harison and Niaina Rakotosamimanana},
journal = {Scientific Reports},
year = {2026},
month = oct,
doi = {10.1038/s41598-026-74038-w},
url = {https://www.nature.com/articles/s41598-026-74038-w},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low rifampicin and early signs of next-line drug resistances: findings from Madagascar’s 2023–24 nationwide drug resistance survey
AU - Rila Ratovoson
AU - Astrid M. Knoblauch
AU - Simon Grandjean Lapierre
AU - Holy N. Andriamamonjisoa
AU - Rado C. Rasoloarisata
AU - Rojovola Randrianarivony
AU - Mamy Serge Raherison
AU - Henry Byabajungu
AU - Hary Seheno Andriambololona
AU - Andrianantenaina Rakotoson
AU - Tojosoa Daniel Ramananjanahary
AU - Rindra Randremanana
AU - Daniella Randriamanana
AU - Richard Mbumba Ngimbi
AU - Eveline Klinkenberg
AU - Michel Tiaray Harison
AU - Niaina Rakotosamimanana
PY - 2026
DA - 2026/10/08
JO - Scientific Reports
DO - 10.1038/s41598-026-74038-w
UR - https://www.nature.com/articles/s41598-026-74038-w
AB - Madagascar’s first national drug-resistance survey (2005-06) reported multidrug-resistant tuberculosis (MDR-TB) in 0.2% of new and 3.4% of retreatment patients. To generate updated resistance estimates, a national cross-sectional, cluster-randomised survey was conducted across 36 diagnostic and treatment centres between April 2023 and April 2024. Bacteriologically confirmed pulmonary TB patients were enrolled and sputum specimens collected for drug-resistance testing, including culture, line-probe assay, Xpert MTB/RIF Ultra, and phenotypic drug-susceptibility testing. Of 2,250 enrolled patients, 1,987 were new (88.3%) and 263 were previously treated (11.7%). Weighted prevalence of rifampicin resistance was 0.2% (95% CI 0.1–0.7%) among new patients and 3.7% (95% CI 1.7–7.8%) among previously treated patients, reflecting stability since the 2005-06 survey. No pre-XDR or XDR-TB was detected. However, resistance to bedaquiline or linezolid was found in 2 of 40 new patients and 2 of 11 retreatment patients among rifampicin- and/or isoniazid-resistant isolates. Overall, the findings indicate a stable and contained RR-TB burden in Madagascar. Sustaining this outcome will require continued investment in case detection, drug-susceptibility testing, effective treatment, and routine resistance surveillance.
SN - 2045-2322
ER -