Yusup Subagio Sutanto
Faculty of Medicine, Sebelas Maret University

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Hubungan Tingkat Pengetahuan tentang PPOK dengan Ketaatan Pengobatan Pasien PPOK di RSUD Dr. Moewardi Caetline, Maria Dewi; Sutanto, Yusup Subagio; Murti, Bhisma
Nexus Kedokteran Komunitas Vol 1, No 1 (2012): Nexus Kedokteran Komunitas
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

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Background: Chronic Obstructive Pulmonary Disease (COPD) is a non-infectious chronic and progressive disease, that has become one of the major causes of morbidity and mortality in the world. The treatment management of COPD is complex. Factors that can optimize treatment include patient acceptance to disease process, knowledge, trust in the treatment, effective patient-doctor communication, and adherence to treatment. This study aimed to analyze the association between knowledge of COPD and adherence to treatment among patients with COPD. Methods: This analytic study was observational with cross-sectional approach. A sample of 40 study subjects was selected by exhaustive sampling from outpatients with COPD visiting the Pulmonary Clinics, RSUD Dr. Moewardi Surakarta. The data were collected by interview using a set of questionnaire. The data was analyszed using multiple logistic regression model on SPSS version 17 for Windows. Results: Patients with high level of knowledge had 20 times as many level of adherence to COPD treatment than those with low level of knowledge (OR=21.01; 95%CI 2.08 to 211.98; p = 0.001). This estimate has controlled for the effects of confounding variables such as payment method, age, and gender. Conclusion: There is a statistically significant association between knowledge of COPD and adherence to treatment among patients with COPD. This conclusion is drawn after controlling for the effects of confounding factors such as payment method, age, and gender. Keywords: COPD, knowledge, adherence to treatment
Hubungan Status Ekonomi dan Tingkat Pengetahuan TB Dengan Keterlambatan Pasien Dalam Diagnosis Kasus TB Paru Selleca, Caesaria Sarah; Sutanto, Yusup Subagio; Reviono, .
Nexus Kedokteran Komunitas Vol 2, No 1 (2013): Nexus Kedokteran Komunitas
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

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Background: Lately, there are a lot of TB cases with late diagnosis. Economic status and knowledge are one of many factor that could lead to late diagnosis in patient with pulmonary tuberculosis. This study aims to know the risk factors of economic status and knowledge to the incidence of TB patient with late diagnosis. Subject and Methods:This study used an observational analytic cross-sectional study approach (cross-sectional). It was held on May to August 2012 in Balai Besar Kesehatan Paru Masyarakat (BBKPM) Surakarta. The research subjects are 60 patient with new cases of pulmonary TB sampled by consecutive sampling method. The subjects were asked to answer a questionnaire about the late diagnosis, economic status (income) and the knowledge of TB. Data were analyzed using multiple linear regression analysis method (multivariate). Results:From 60 samples, there are 31 people with low economic status and 29 people with high economic status. Samples with high TB knowledge are 34 people and samples with low TB knowledge are 26 people. There are 38 people with late diagnosis and 22 people do not experience the late diagnosis. Economic status (income) has an effect on patient late diagnosis. Patients with lower incomes, on average, visit for the first time to a health facility 165.68 days slower than those with higher incomes (b: 165.68; 95% CI -33.21 s / d 364.56, p = 0.101) .Patients knowledge about TB also has an effect on patient late diagnosis. Patients with a low level of TB knowledge, on average, visit for the first time to a health facility 128.84 days slower than patients with high levels of TB knowledge (b: 128.84; 95% CI -71.73 s / d 329.40, p = 0.204). Conclusions:There is a relationship between economic status and level of knowledge of TB with patients delay, but the results were not statistically significant. Keywords: economic status, level of knowledge of TB, the patient delays
Hubungan Diabetes mellitus dengan Hasil Uji Konversi BTA Sputum setelah Pemberian Terapi Tuberkulosis Tahap Inisiasi Pranoto, Avamira Rosita; Sutanto, Yusup Subagio; Haryati, Sri
Nexus Kedokteran Klinik Vol 3, No 1 (2014): Nexus Kedokteran Klinik
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

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Background: Pulmonary tuberculosis (TB) is a chronic infection of lung caused by Mycobacterium tuberculosis. Tuberculosis treatment often gets failure in result because of lack of care in co-morbid disease such as Diabetes mellitus (DM), which can disturb TB patient immunity. The objective of this study was to determine the relation of Diabetes mellitus and result of conversion test of sputum with alcohol-acid resistant bacillus after initiation phase of tuberculosis medication. Methods: This was an observational analytic survey with retrospective cohort study. Using consecutive sampling method, this study took 124 patients from RSUD Dr. Moewardi and BBKPM (Balai Besar Kesehatan Paru Masyarakat) Surakarta, who divided into 2 groups based on the DM status of newly diagnosed pulmonary TB patients. Control group consisted of 86 newly diagnosed pulmonary TB patients without DM; exposure group consisted of 38 newly diagnosed pulmonary TB patients with DM. Patients from both groups were given category-1 tuberculosis treatment during 2 months of initiation phase therapy, then the BTA conversion status of patients was observed. Data collected through the medical record and concurrent data of pulmonary TB patients. Data was analyzed by SPSS using Chi Square test. Probability (p) is < 0.05 with 95% confident interval. Results: There were 14 patients from the control group who failed to undergo conversion after 2 months of initiation phase therapy, whereas from the exposure group, there were 17 patients who got failure in result. Data analysis using Chi Square with significance level p < 0.05 was obtained p = 0.001 and Relative Risk (RR) = 0.66. Conclusions: DM seems to have a negative impact on the outcome of tuberculosis treatment. Pulmonary tuberculosis patients with DM as comorbid disease has probability 0.66 times lower than those without DM to get positive result from BTA sputum conversion test. Screening for DM and subsequent blood glucose control may improve the outcome of tuberculosis treatment. Keywords: Diabetes mellitus, tuberculosis medication, result of conversion test of sputum 
Pengaruh Faktor Risiko terhadap Waktu Timbulnya Efek Samping Kanamisin pada Tuberkulosis Resistan Obat Wati, Martha Ratna; Reviono, Reviono; Putranto, Wachid; Sutanto, Yusup Subagio; Harsini, Harsini
Majalah Kedokteran Bandung Vol 50, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (540.161 KB) | DOI: 10.15395/mkb.v50n2.1297

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Kanamisin adalah obat untuk terapi tuberkulosis resistan obat (TB RO) yang menimbulkan efek samping gangguan pendengaran, gangguan fungsi ginjal, dan gangguan elektrolit terutama hipokalemia. Penelitian bertujuan menilai kesintasan waktu timbulnya efek samping dan pengaruh faktor risiko usia, riwayat terapi streptomisin serta berat badan terhadap efek samping akibat pemberian kanamisin pasien TB RO. Penelitian kohort retrospektif dari data rekam medis pasien TB RO dari Januari 2011 sampai April 2017 di RSUD Dr. Moewardi Surakarta. Analisis pengaruh faktor risiko terhadap efek samping menggunakan uji cox regression. Dari 238 pasien didapatkan gangguan pendengaran 143 pasien, gangguan fungsi ginjal 147 pasien, dan hipokalemia 169 pasien. Usia lebih dari 40 tahun hazard ratio (HR) 2,419 (IK: 95%; 1,716–3,409; p= 0,000) dan jenis kelamin perempuan HR: 1,549 (IK: 95%; 1,089–2,202; p= 0,015) berisiko terjadi gangguan pendengaran. Usia lebih dari 40 tahun HR: 1,892 (IK: 95%; 1,353–2,646; p= 0,000) dan jenis kelamin perempuan HR: 1,667 (IK: 95%; 1,179–2,357; p= 0,004) berisiko terjadi gangguan fungsi ginjal. Riwayat streptomisin sebelumnya dan indeks massa tubuh (IMT) tidak berisiko timbul efek samping akibat pemberian kanamisin. Pengawasan ketat timbulnya efek samping gangguan pendengaran dan gangguan fungsi ginjal pasien usia lebih dari 40 tahun dan perempuan pada pengobatan TB RO.Kata kunci: Efek samping, gangguan fungsi ginjal, gangguan pendengaran, kanamisin, TB resistan obat Effects of Risk Factors on the Onset of Kanamycin’s Adverse Events in Drug Resistant TuberculosisKanamycin is a therapy for drug-resistant tuberculosis (TB) which may cause hearing loss, impaired kidney function, and electrolyte disorders, especially hypokalemia. The objective of this study was to assess patient survival and the effects of risk factors such as age, previous history of streptomycin therapy, and weight on adverse events due to kanamycin administration in patients with drug resistant TB. A retrospective cohort study was conducted in TB patients by using medical records from January 2011 to April 2017 in Dr. Moewardi Hospital Surakarta. Cox regression analysis was used to analyze the relation between risk factors and adverse events. Of 238 patients, 143 patients experienced hearing loss, 147 patients experienced impaired kidney function, and 169 patients had hypokalemia. Age over 40 and female gender had higher risks for hearing loss and impaired kidney function (HR: 2.419 (95% CI: 1.716–3.409; p= 0,000) and HR: 1,892 (95% CI: 1.353–2.646; p=0,000); HR: 1.549 (95%CI: 1.089–2.202; p=0,015), and HR: 1.667 (95% CI: 1.179–2.357; p=0.004)), respectively. History of streptomycin and body mass index (BMI) were not risk factors for  kanamycin’s adverse events. Therefore, closed monitoring on hearing loss and impaired kidney function is necessary for drug resistant TB patients aged over 40, and female patients. Key words: Adverse events, drug resistant tuberculosis, hearing loss, impaired kidney function, kanamycin
Para-aortic and Meningitis Tuberculosis: A Case Report Reviono, Reviono; R, Sari Apriliana; Sutanto, Yusup Subagio; Soetejo, FX; Subandrio, Subandrio
Indonesian Journal of Medicine Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: In 2018, Indonesia was in third place as the country with the highest incidence of tuberculosis (TB) in the world. In addition to pulmonary TB, extrapulmonary TB cases are also quite large. Lymphadenitis of the aortic TB can cause a fatal risk if not treated immediately. This study aimed to explore the para-aortic and meningitis tuberculosis case in Klaten Hospital, Central Java.Case presentation: There was a 24-year-old woman with complaints of missing chest pain for 2 months, fear of seeing light (photophobia), and decreased consciousness. The patient was a referral from Klaten Hospital with a diagnosis of a mediastinal tumor. The chest radiograph shows a picture of homogeneous opacity in the anterior mediastinum. Bronchoscopy results show compression stenosis in 1/3 distal and blunt carina. After a sternotomy, it was obtained pus (pus) and tissue granuloma in the area of the aorta. After the rapid molecular test was carried out, the results showed that M tuberculosis detected. The results of histopathology of anatomical pathology show epitheloid tubercle and Datia Langhans cells that suggest an infection with M. tuberculosis. Therapy was done by giving a standard anti-tuberculosis drug, namely Rifampicin 450 mg, INH 300 mg, Ethambutol 1000 mg, and Pyrazinamide 1000 mg. The patient's condition improved marked by weight gain in 2 months.Conclusion: In the case of pulmonary masses (mediastinal tumors), we need to be aware of the possibility of cases of TB lymphadenitis because Indonesia is a country with a high prevalence of TB. This is because a slow diagnosis can lead to life-threatening conditions Keywords: Tuberculosis, para aorta lymphadenitis, meningitis TB, tumor mediastinum, sternotomyCorrespondence: Reviono. Department of Pulmonology and Medical Respiration, Universitas Sebelas Maret Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: reviono@staff.uns.ac.id. Mobile: +6281­8474671.Indonesian Journal of Medicine (2019), 4(3): 201-210https://doi.org/10.26911/theijmed.2019.04.03.02
LEVEL OF CONFORMITY EXAMINATION OF URIC ACID LEVELS IN PLEURAL FLUID, RATIO OF URIC ACID LEVELS IN PLEURAL FLUID WITH SERUM TO DISTINGUISH EXUDATES AND TRANSUDATES Sigit, Indarto; Sutanto, Yusup Subagio; Harsini, Harsini
Jurnal Respirologi Indonesia Vol 40, No 2 (2020)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v40i2.100

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Background: Uric acid can be used as a biomarker to distinguish transudates from pleural fluid exudates. Uric acid is soluble in liquid media, elevated levels of uric acid in blood plasma become a predisposing factor for uric crystal deposits in tissues and body fluids. Increased permeability due to changes in capillary pleural pressure in the formation of transudates is a cause of increased levels of uric acid in pleural fluid. The aim of the study was to analyze the examination of pleural fluid uric acid levels and the ratio of uric acid levels to pleural fluid to serum to distinguish exudates and transudates in pleural effusion. Methods: A cross sectional diagnostic test with a cross sectional study design in pleural effusion patients at RSUD Dr. Moewardi Surakarta in July-August 2019. Subjects were examined for pleural fluid levels, serum uric acid ratio, and pleural fluid analysis. Results: A total of 30 pleural effusion patients were included in this study. The level of agreement between the uric acid pleural fluid against Light criteria was in the moderate category and statistically significant (Kappa = 0.595; P=0.001). The level of agreement between the ratio of uric acid to pleural fluid and serum to Light's criteria was weak and not statistically significant (Kappa = 0.200; p = 0.195) Conclusion: The level of concordance between pleural fluid uric acid with Light criteria is in the medium category and statistically significant. There is no match between the ratio of serum pleural fluid uric acid levels with Light criteria. (J Respir Indo. 2020; 40(2): 82-6)
The Relationship of Amount of Pleural Fluid and Time of Pleurodesis with the Results of Pleurodesis in Malignant Pleural Effusions Sutanto, Yusup Subagio; Sigit, Indarto; Kurniawan, Hendra
Indonesian Journal of Medicine Vol 5, No 4 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Pleural effusion can be an early sign of lung cancer in more than 25% of cases. Lung cancer is the most common cause of ma­lignant pleural effusion (MPE). Pleuro­desis is performed when the amount of pleu­ral fluid is <150 ml/day, but it is difficult as its productive nature. This study aimed to find the right time to perform pleurodesis on patients with MPE, which is expected to achieve optimal results.Subjects and Method: This was a cross-sec­tio­nal study conducted at Dr. Moewardi Hos­pital, Surakarta, Central Java, from June to July 2020. The study subjects were 17 pati­ents with malignant pleural effusion (MPE) diag­nos­ed with lung cancer who underwent water seal drainage (WSD) and indicated for pleurodesis. The dependent variable was the success of the pleurodesis procedure. The independent varia­bles were the amount of evacuated pleural fluid and the time of pleu­rodesis performed. The stu­dy instruments were diagnosis of lung cancer with anatomic pathology, measurement of the amount of pleural fluid, and posteroanterior chest X-ray evaluating the success of pleuro­desis. The data were analyzed using Spearman corre­lation, ANOVA to determine the differen­ces in the amount of pleural fluid at the first, second, and third hours, and continued with post hoc LSD analysis using SPSS 21.Results: The pleurodesis success rate had posi­tive correlation with the amount of pleural fluid (r= 0.24; p= 0.345) and the time of pleu­ro­­desis performed at the first hour (r= 0.10; p= 0.701), second hour (r= 0.03; p= 0.921), and third hour (r= 0.41; p= 0.106). Pleurodesis per­form­ed at the second hour had the lowest amount of pleural fluid (Mean= 84.66; SD= 38.88), followed by third hour (Mean= 110.77; SD= 65.57), and first hour (Mean= 111.22; SD= 57.83), but the differences were not statistically significant (p= 0.285).Conclusion: The pleurodesis success rate has a positive correlation with the amount of pleu­ral fluid and the time of pleurodesis, but it was not statistically significant. There is no signifi­cant difference in the amount of pleural fluid eva­cuated at the three different times of pleuro­desis. The least amount of pleural fluid obtains at the second hour (14.00-22.00).Keywords: malignant pleural effusion, amou­nt of pleural fluid, pleurodesis, pleuro­desis timeCorrespondence: Yusup Subagio Sutanto. Department of Pul­mo­­­no­logy and Respiratory Medicine, Fa­culty of Me­di­cine Universitas Sebelas Maret, Dr. Moewar­di Hospital, Surakarta. Jl. Kolonel Sutarto 132, Surakarta 57126, Central Java. Email: dr_­yusupsubagio­@yahoo.com. Mobile: +628112­8­­4165.Indonesian Journal of Medicine (2020), 05(04): 337-342https://doi.org/10.26911/theijmed.2020.05.04.09. 
Determinants of Delay in Diagnosis and Treatment in Multi Drug-Resistant Tuberculosis Patients in Health Facilities Sutanto, Yusup Subagio; Murti, Paulus Wisnu Kuncoro; Reviono, Reviono; Probandari, Ari Natalia; Kurniawan, Hendra
Indonesian Journal of Medicine Vol 6, No 1 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Multidrug-resistant tubercu­lo­sis (MDR-TB) is a serious threat to global TB control programs. According to WHO, there are 23,000 cases of TB multidrug-/rifampicin-resistant (MDR/RR-TB) in Indonesia. In 2017, there were 442,000 of TB cases. There were 8,600 - 15,000 MDR/RR-TB cases, of which 2.4% were new cases and 13% were previously treated TB cases. This study aims to determine the factors that influence the delay in diagnosis and treatment of MDR-TB patients.Subjects and Method: This study was a cross-sectional study conducted at Dr. Moe­wardi hospital, from Sep­tem­ber to October 2017, Surakarta, Central Java. A sample of 73 MDR-TB patients with disabilities on medical records was selected for this study. The depen­dent variables were delay in diagnosis and delay in therapy of MDR-TB cases. The inde­pendent variables were age, gender, distance to health facilities, and type of health facilities. Data were collected from medical records of MDR-TB patients who were treated from March 2012 to March 2017. Data were analyzed using the chi-square model.Results: Median delay in diagnosis = 4 days. Median treatment delay = 12 days. The average patient who had delayed MDR-TB therapy (≥4 days) was 44 years old (Mean= 44.19; SD= 12.64). Delay in MDR-TB diagnosis was not significantly associated with gender (OR= 0.53; 95% CI= 0.18 to 1.57; p= 0.264), distance to health facility (OR= 1.56; 95% CI= 0.58 to 4.21; p= 0.389), and type of health facility (OR= 0.60; 95% CI= 0.26 to 1.41; p= 0.983). The average of patient who had delayed MDR-TB therapy (≥12 days) was 41 years old (Mean= 41.39; SD= 12.69). Treatment delay was not significantly related to gender (OR= 0.45; 95% CI= 0.16 to 1.26; p= 0.137), distance to health facility (OR=1.44; 95% CI= 0.55 to 3.78; p= 0.466), and type of health facility (OR= 2.31; 95% CI= 1.03 to 5.21; p= 2.967).Conclusion: There was no statistically sig­nificant relationship between gender, dis­tance from the patient's home to health facilities, and type of health facility with the delay in diag­nosis and treatment of MDR-TB patients.Keywords: diagnosis, treatment, TB-MDRCorrespondence: Yusup Subagio Sutanto. Department of Pulmo­nology and Respiratory Medicine, Faculty of Medicine Universitas Sebelas Maret/ Dr. Moe­wardi Hospital, Surakarta. Jl. Kolonel Sutarto No.132, Jebres, Surakarta, Central Java 57126. Email: dr_yusupsubagio@yahoo.com. Mobile: 0811284165.Indonesian Journal of Medicine (2021), 06(01): 14-22https://doi.org/10.26911/theijmed.2021.06.01.02. 
Accuracy of Uric Acid and Cholesterol Levels Examination in Distinguishing Pleural Effusion Fluid Exudates and Transudates Sutanto, Yusup Subagio
Indonesian Journal of Medicine Vol 6, No 2 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Light's criteria was reported 25% of misclassification transudates as exu­dates. This study aimed to analyse the accuracy of examining uric acid levels and pleural fluid uric acid levels, and pleural fluid cholesterol and cholesterol ratios to distinguish the exudates and transudates in pleural effusions.Subjects and Method: This was a cross-sectional study de­sign conducted at Dr. Moe­wardi Hospital, Surakarta, Central Java, from July to August 2019. The study subjects were 30 pleural effusion patients treated in the pul­monology ward. The dependent variables were pleural fluid exudates and transudates. The indepen­dent variables were (1) Uric acid levels in pleu­ral fluid; (2) The ratio of uric acid levels be­tween pleural fluid and serum; (3) Pleural fluid cholesterol levels; and (4) The ratio of cho­lesterol levels between pleural fluid and serum. The study instruments were Light's cri­teria and laboratory examination. The diag­nosis's accuracy was analysed using sensi­tivi­ty, specificity, and the area under the ROC (AUC) curve.Results: Pleural fluid cholesterol showed sen­­sitivity and specificity of 86% and 83%, with a cut-off of 32.00 for transudate results. AUC value = 0.82 with p = 0.012. Serum cholesterol showed sensitivity and specificity of 71% and 61%, with a cut-off of 175.50 for transudate re­sults. AUC value = 0.67 with p = 0.194. Pleu­ral fluid uric acid levels showed a sensitivity and specificity of 86% and 87%, with a cut-off of 7.25 for transudate results. AUC value = 0.83 with p = 0.009. Examination of serum uric acid levels showed a sensitivity and specificity of 86% and 70%, with a cut-off of 7.10 for trans­udate results. AUC value = 0.65 with p = 0.249.Conclusion: Examination of uric acid and pleural fluid cholesterol levels can be used in routine pleural effusion examinations to distin­guish exudates and transudates.Keywords: accuracy, uric acid, exudates, cho­les­te­rol, transudatesCorrespondence: Yusup Subagio Sutanto. Department of Pul­mo­no­logy and Respiratory Medicine, Faculty of Medicine Universitas Sebelas Maret, Dr. Moe­wardi Hospital, Surakarta. Jl. Kolonel Sutarto 132, Jebres, Surakarta 57126, Central Java. Email: dr_yusupsubagio­@yahoo.com. Mobile: +62811284165.Indonesian Journal of Medicine (2021), 06(02): 159-167https://doi.org/10.26911/theijmed.2021.06.02.05 
Anti-Tuberculosis Drugs against the Resistance Level of Mycobacterium tuberculosis isolates Sutanto, Yusup Subagio; Sutanto, Magdalena Sutanto; Harti, Agnes Sri
KEMAS: Jurnal Kesehatan Masyarakat Vol 17, No 1 (2021)
Publisher : Department of Public Health, Faculty of Sport Science, Universitas Negeri Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v17i1.24158

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Prolonged MDR-TB therapy can have side effects, namely a correlation between cure rates and changes in bacterial profiles related to resistance to anti-tuberculosis drugs (ATD) which can affect the incidence rate of MTB and MDR-TB in a region. The research objective was to analyze the effectiveness of the type of ATD against the resistance level of Mycobacterium tuberculosis (MTB) isolates with the incidence of tuberculosis (TB) and MDR-TB. The research method used was a retrospective cohort based on tracing medical record data at the Surakarta City Center General Hospital 2016 until 2017 with total sampling. The independent variable of this study was the type of ATD, while the dependent variable was the resistance level of MTB isolates. The characteristics of the most patient respondent suspect TB were male with the level of resistance of MTB isolates to ATD relatively varied. The results of the analysis of different tests showed a p value of 0.000 so that the p value was <0.05, so there was an effect of the type of ATD (Strepttomycin, Isoniazid, Rifampicin and Ethambutol) on the resistance of TB isolates from patients with suspected TB. This is useful to determine the success of TB therapy in terms of mortality and the effectiveness of therapy in TB patients.