Successful alternative treatment of extensively drug-resistant tuberculosis in Argentina with a combination of linezolid, moxifloxacin and thioridazine
Successful alternative treatment of extensively drug-resistant tuberculosis in Argentina with a combination of linezolid, moxifloxacin and thioridazine
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DOI：
10.1093/jac/dkr500
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发表时间：
2012-02-01
影响因子：
5.2
通讯作者：
van Soolingen, Dick
中科院分区：
文献类型：
--
作者：
Abbate, Eduardo;Vescovo, Marisa;van Soolingen, Dick
目的：目前治疗广泛耐药（XDR）结核病（TB）的药物选择很少；因此，关于替代方案的安全性、耐受性和有效性的信息是至关重要的。本研究的目的是描述一系列广泛耐药结核病患者的管理，药物不良反应和替代联合治疗的结果。患者和方法：2002年至2008年期间，对布宜诺斯艾利斯传染病转诊治疗中心收治的17名非艾滋病、患有广泛耐药结核病的肺部成年患者进行了回顾性研究。药敏试验在常规能力测试下进行，并在国家结核病参比实验室得到确认。结果：所有患者的用药方案均纳入利奈唑胺；莫西沙星和/或噻嗪纳入14例患者的方案。9例患者观察到临床可处理的药物不良反应，最常见的是血液系统疾病和神经毒性。2例患者停用硫硝嗪。15例患者实现阴性培养转化，11例完成治疗符合治愈标准，4例仍在随访，进展良好，1例未接受治疗，1例失访。结论：利奈唑胺、莫西沙星和噻嗪联合用药建议在具有管理广泛耐药结核病专业知识的专门中心进行同情性使用。
Objectives: Current drug choices to treat extensively drug-resistant (XDR) tuberculosis (TB) are scarce; therefore, information on the safety, tolerability and efficacy of alternative regimens is of utmost importance. The aim of this study was to describe the management, drug adverse effects and outcome of alternative combined treatment in a series of XDR-TB patients.Patients and methods: A retrospective study was performed on 17 non-AIDS, pulmonary adult patients with XDR-TB admitted to a referral treatment centre for infectious diseases in Buenos Aires from 2002 through 2008. Drug susceptibility testing was performed under regular proficiency testing and confirmed at the national TB reference laboratory.Results: Linezolid was included in the drug regimens of all patients; moxifloxacin and/or thioridazine were included in the regimens of 14 patients. Clinically tractable drug adverse effects were observed in nine patients, the most frequent being haematological disorders and neurotoxicity. In two patients, thioridazine was discontinued. Negative culture conversion was achieved in 15 patients, 11 completed treatment meeting cure criteria, 4 are still on follow-up with good evolution, 1 defaulted treatment and 1 was lost to follow-up.Conclusions: The combination of linezolid, moxifloxacin and thioridazine is recommended for compassionate use in specialized centres with expertise in the management of XDR-TB.