Multidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment
Multidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment
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DOI：
10.1093/bmb/ldh047
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发表时间：
2005-01-01
影响因子：
6.7
通讯作者：
Ormerod, LP
中科院分区：
文献类型：
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作者：
Ormerod, LP
耐多药结核病(MDR-TB)是一个日益严重的全球性问题，大多数病例是由于在治疗易感结核病过程中医生的失误和患者的不遵医造成的。耐多药结核病的范围和负担因国家和地区的不同而有很大差异。与结核病本身一样，耐多药结核病的压倒性负担发生在资源贫乏的高负担国家。诊断依赖于确认隔离生物的药物敏感性模式，这通常只有在资源丰富的环境中才可能实现。在有既往治疗病史或治疗失败的病例中，应强烈怀疑存在耐药性，包括耐多药结核病。发达国家的治疗费用很高，需要根据药物敏感性数据和储备药物的使用情况进行个体化治疗。在资源匮乏的情况下，可以使用世卫组织的再治疗方案，但越来越多的是在受支持的国家结核病规划中采用基于直接监督治疗的“DOTS+”方案。然而，即使在给予这种治疗的情况下，患者的结果也比完全易感的结核病严重得多，而且成本要高得多。
Multidrug-resistant tuberculosis (MDR-TB) is an increasing global problem, with most cases arising from a mixture of physician error and patient non-compliance during treatment of susceptible TB. The extent and burden of MDR-TB varies significantly from country to country and region to region. As with TB itself, the overwhelming burden of MDR-TB is in high-burden resource-poor countries. The diagnosis depends on confirming the drug susceptibility pattern of isolated organisms, which is often only possible in resource-rich settings. There should be a strong suspicion of drug resistance, including MDR-TB, in persons with a history of prior treatment or in treatment failure cases. Treatment in developed countries is expensive and involves an individualized regimen based on drug susceptibility data and use of reserve drugs. In resource-poor settings a WHO retreatment regimen may be used, but increasingly the move is to a directly observed treatment based 'DOTS-plus' regimen in a supported national TB programme. However, even where such treatment is given, the outcome for patients is significantly worse than that for fully susceptible TB and has a much higher cost.