Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis
Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis
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DOI：
10.1016/s1473-3099(10)70139-0
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发表时间：
2010-09-01
影响因子：
56.3
通讯作者：
Migliori, Giovanni Battista
中科院分区：
文献类型：
--
作者：
Caminero, Jose A.;Sotgiu, Giovanni;Migliori, Giovanni Battista
耐多药结核病和广泛耐药结核病通常被认为具有高死亡率。然而，许多病例可以通过正确组合和合理使用现有抗结核药物来治疗。本综述描述了每种药物的现有证据，并讨论了建议治疗耐多药和广泛耐药结核病患者的依据。推荐的治疗方案是联合使用至少四种结核分枝杆菌分离物可能敏感的药物。根据疗效、安全性和成本，通过五组逐步选择药物。在第一组（口服一线药物）中，大剂量异烟肼、吡嗪酰胺和乙胺丁醇被认为是治疗耐多药和广泛耐药结核病的辅助药物。第二组为氟喹诺酮类药物，其中首选大剂量左氧氟沙星。第三类为注射用药，用药顺序为：卷曲霉素、卡那霉素、阿米卡星。第四组称为二线药物，应按以下顺序使用硫胺类药物、环丝氨酸、然后是氨基水杨酸。第五类药物包括不是很有效的药物或缺乏临床数据的药物。第五组用药顺序：氯法齐明、阿莫西林联合克拉维酸、利奈唑胺、碳青霉烯类、硫代乙酰酮、克拉霉素。
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are generally thought to have high mortality rates. However, many cases can be treated with the right combination and rational use of available antituberculosis drugs. This Review describes the evidence available for each drug and discusses the basis for recommendations for the treatment of patients with MDR and XDR tuberculosis. The recommended regimen is the combination of at least four drugs to which the Mycobacterium tuberculosis isolate is likely to be susceptible. Drugs are chosen with a stepwise selection process through five groups on the basis of efficacy, safety, and cost. Among the first group (the oral first-line drugs) high-dose isoniazid, pyrazinamide, and ethambutol are thought of as an adjunct for the treatment of MDR and XDR tuberculosis. The second group is the fluoroquinolones, of which the first choice is high-dose levofloxacin. The third group are the injectable drugs, which should be used in the following order: capreomycin, kanamycin, then amikacin. The fourth group are called the second-line drugs and should be used in the following order thioamides, cycloserine, then aminosalicylic acid. The fifth group includes drugs that are not very effective or for which there are sparse clinical data. Drugs in group five should be used in the following order: clofazimine, amoxicillin with clavulanate, linezolid, carbapenems, thioacetazone, then clarithromycin.