Salvage therapy for multidrug-resistant tuberculosis.
Salvage therapy for multidrug-resistant tuberculosis.
复制标题
DOI：
10.1111/1469-0691.12335
复制
发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
K. Seung;K. Seung;M. Becerra;M. Becerra;M. Becerra;S. Atwood;F. Alcántara;C. Bonilla;C. Mitnick;C. Mitnick;C. Mitnick
中科院分区：
文献类型：
--
作者：
K. Seung;K. Seung;M. Becerra;M. Becerra;M. Becerra;S. Atwood;F. Alcántara;C. Bonilla;C. Mitnick;C. Mitnick;C. Mitnick
耐多药结核病（MDR-TB）被定义为对异烟肼和利福平都具有耐药性的结核分枝杆菌，在最好的情况下，特别是在资源有限的情况下，其治疗具有挑战性。对于尽管接受了二线结核病药物治疗，但痰培养仍持续呈阳性的患者，治疗选择有限，特别是如果疾病过于严重，无法进行手术治疗。挽救疗法是指在宣布治疗失败之前，结合新药物和以前使用的药物，最后努力达到痰转化的方案设计。我们回顾性评估了213名秘鲁患者的抢救治疗结果。救助方案中位数包括两种新药（范围1-6）和九种（范围5-13）总共（新加以前使用的）药物。使用频率最高的是莫西沙星，其次是卷曲霉素、阿莫西林-克拉维酸、卡那霉素和克拉霉素。65例（30.5%）患者发生培养转化。包括莫西沙星的挽救方案更有可能遵循培养转化（OR 2.2; p 0.02）。如果最佳临床策略是在患者有最佳治愈机会时使用最有效的药物，那么下一代氟喹诺酮类药物，如莫西沙星，应用于挽救治疗，但也应用于耐多药结核病的初始治疗。新的结核病药物最初最有可能用于与本文描述的情况类似的救助性患者。对这些患者进行密切的细菌学监测将是必不可少的，因为可以从抢救治疗队列的分析中获得有关使用这些新药的最佳方法的有用信息。
Treatment of multidrug-resistant tuberculosis (MDR-TB), defined as Mycobacterium tuberculosis resistant to both isoniazid and rifampicin, is challenging under the best of circumstances, and particularly in resource-limited settings. For patients who remain persistently sputum-culture-positive despite therapy with second-line TB drugs, treatment options are limited, especially if disease is too advanced for resective surgery. Salvage therapy refers to the design of a regimen combining new and previously used drugs in a final effort to attain sputum conversion before declaring treatment to have failed. We retrospectively evaluated the outcomes of salvage therapy in 213 Peruvian patients. Salvage regimens included a median of two new drugs (range 1-6) and nine (range 5-13) total (new plus previously used) drugs. The most frequently used new drug was moxifloxacin, followed by capreomycin, amoxicillin-clavulanate, kanamycin and clarithromycin. Culture conversion occurred in 65 (30.5%) patients. Salvage regimens that included moxifloxacin were significantly more likely to be followed by culture conversion (OR 2.2; p 0.02). Later-generation fluoroquinolones such as moxifloxacin should be used in salvage therapy but also in the initial treatment of MDR-TB, if the best clinical strategy is to use the most effective drugs when the patient has the best chance for cure. New TB drugs are most likely to be initially used in salvage patients, in conditions similar to those described here. Close bacteriological monitoring of these patients will be essential, as useful information about the best way to use these new drugs can be gained from analysis of salvage therapy cohorts.