Criteria for the control of drug-resistant tuberculosis
Criteria for the control of drug-resistant tuberculosis
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DOI：
10.1073/pnas.140102797
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发表时间：
2000-07-05
影响因子：
11.1
通讯作者：
Williams, BG
中科院分区：
文献类型：
--
作者：
Dye, C;Williams, BG
抗生素耐药性是全世界控制传染病的一个日益严重的障碍，其中包括结核病。结核病每年造成200万人死亡，在东欧、非洲、亚洲和拉丁美洲已经发现了耐多药结核病（MDR-TB）的病灶。卫生政策的一个关键问题是，以廉价的一线药物为基础的结核病标准化短程化疗能否预防和扭转耐药性的传播。在这里，我们使用数学模型，结合来自六个国家的治疗结果，表明最佳实践的短程化疗很可能使对异烟肼和利福平这两种关键药物中的任何一种耐药的菌株得到控制，并防止耐多药结核病的出现，但是，一旦出现耐多药结核病，就不一定能控制它，部分原因是治愈率太低。我们估计，每年大约70%的流行性、传染性耐多药结核病病例应得到发现和治疗，其中至少80%应得到治愈，以防止耐多药结核病的爆发。不良控制方案的目标应该是同时提高病例发现率和治愈率，原因有三：（i）这些变量协同作用;（ii）当其中一个变量较低时，另一个变量不能单独成功;（iii）提高耐多药结核治愈率所需的二线药物很少，而且成本极高。我们讨论了这些结果对世界卫生组织抗生素耐药性管理政策的影响。
Antibiotic resistance is a growing impediment to the control of infectious diseases worldwide, tuberculosis (TB) being among them. TB kills two million people each year and foci of multidrug-resistant TB (MDR-TB) have been identified in Eastern Europe, Africa, Asia, and Latin America. A critical question for health policy is whether standardized short-course chemotherapy for TB, based on cheap first-line drugs, can prevent and reverse the spread of drug resistance. Here we use mathematical modeling, in conjunction with treatment results from six countries, to show that best-practice short-course chemotherapy is highly likely to bring strains resistant to either of the two key drugs isoniazid and rifampicin under control and to prevent the emergence of MDR-TB, However, it is not certain to contain MDR-TB once it has emerged, partly because cure rates are too low. We estimate that approximately 70% of prevalent, infectious MDR-TB cases should be detected and treated each year, and at least 80% of these cases should be cured, in order to prevent outbreaks of MDR-TB. Poor control programs should aim to increase case detection and cure rates together for three reasons: (i) these variables act synergistically; (ii) when either is low, the other cannot succeed alone; and (iii) the second-line drugs needed to raise MDR-TB cure rates are few and extremely costly. We discuss the implications of these results for World Health Organization policy on the management of antibiotic resistance.