A community-based tuberculosis case-finding and short-course chemotherapy program was conducted in a suburb of Manila and featured 1 month of daily isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) followed by 7 months of twice-weekly, high dose, directly observed INH + EMB + PZA. Church-affiliated lay workers obtained 1,990 sputum specimens from subjects who complained of chronic cough or wasting symptoms; 207 of the specimens were positive on Ziehl-Neelsen smears. On culture, 176 yielded a significant growth of M. tuberculosis. Of these 176 patients, 144 were selected to enter the study; 10 were lost because of withdrawal or death and four (2.7%) because of drug toxicity. This left 130 patients who were followed long-term. Remarkably, 80% (104) were initially shedding drug-resistant organisms; 26% (34) were resistant to one drug, 30% (40) were resistant to two drugs, and 24% (30) were resistant to three or more drugs. Responses to therapy corresponded closely to the extent of drug resistance: 80% (48 of 60) of patients with drug-susceptible or single resistance had a favorable outcome; 43% (28 of 65) were resistant to two or three drugs, and 0% (0 of 5) of those were resistant to four or more drugs. Notable findings of this study were the success of a community-based program in conducting prolonged, directly observed treatment, the unexpectedly high prevalence of multiple-drug-resistant organisms in this population, and the inadequacy of INH + PZA + EMB during the continuation phase of therapy in this setting.

Background: HIV patients with a weak immune system are very vulnerable to opportunistic infections, can trigger systemic endothelial activation and end up as a condition of sepsis. In Indonesia currently, there is no bacterial epidemiological mapping of the etiology of opportunistic infections in HIV patients. Purpose: To determine the pattern of bacteria that cause opportunistic infections and their antibiotic sensitivity in HIV patients. Method: Prospective observational study design. Data were obtained from medical records of hospitalized patients at RSUD Dr. Soetomo Surabaya from August 2019 - February 2020. Result: Out of 64 patients, 83 specimens were found with the most types of gram-negative bacteria 44.6%, while gram-positive bacteria were 15.7% and a mix of 2.4% and 37.3% negative culture. The highest prevalence of gram-negative bacteria was Klebsiella pneumoniae (35.15), followed by Escherichia coli (10.8%), Pseudomonas aeruginosa (8.1%), and Acinetobacter baumanii (8.1%). The highest prevalence of gram-positive bacteria was Streptococcus mitis / oralis (30.7%), followed by Staphylococcus aureus (23.1%) and Staphylococcus epidermidis (15.4%). Among gram-negative bacteria antibiotic, Cefoperazone-sulbactam showed the greatest sensitivity, following by Amikacin, Gentamycin and Piperacillin-tazobactam; while among gram-positive bacteria are Chloramphenicol, Linezolid, and Vancomycin. Almost all isolates showed resistance to Ampicillin. Conclusion: Bacteria pattern that caused opportunistic infection in RSUD Dr. Soetomo is K. pneumonia as most common gram-negative bacteria followed by E. coli, P. aeruginosa and A. baumanii; while the most gram-positive bacteria found are S. mitis/oralis and S. aureus. Among antibiotic used, Ampicillin showed the lowest sensitivity to almost all bacteria isolates.