Comprehensive treatment of extensively drug-resistant tuberculosis.
Comprehensive treatment of extensively drug-resistant tuberculosis.
复制标题
DOI：
10.1056/nejmoa0800106
复制
发表时间：
2008-08-07
期刊：
影响因子：
--
通讯作者：
Becerra MC
中科院分区：
文献类型：
--
作者：
Mitnick CD;Shin SS;Seung KJ;Rich ML;Atwood SS;Furin JJ;Fitzmaurice GM;Alcantara Viru FA;Appleton SC;Bayona JN;Bonilla CA;Chalco K;Choi S;Franke MF;Fraser HS;Guerra D;Hurtado RM;Jazayeri D;Joseph K;Llaro K;Mestanza L;Mukherjee JS;Muñoz M;Palacios E;Sanchez E;Sloutsky A;Becerra MC
45个国家报告了广泛耐药结核病，包括资源有限和结核病负担高的国家。我们描述了广泛耐药结核病的管理和治疗结果的患者谁被转介个体化门诊治疗在秘鲁。共有810名患者接受了免费的个性化治疗，包括药物治疗、切除手术、不良事件管理、营养和社会心理支持。我们测试了来自651名广泛耐药结核病患者的分离株，并制定了包括五种或更多感染分离株不耐药的药物的方案。在接受检测的651名患者中，48名（7.4%）患有广泛耐药结核病；其余603例患者为耐多药结核病。广泛耐药结核病患者比其他患者接受了更多的治疗（平均[±SD]方案数，4.2±1.9比3.2±1.6，P<0.001），并且分离株对更多的药物耐药（药物数，8.4±1.1比5.3±1.5，P<0.001）。所有广泛耐药结核病患者均未合并感染人类免疫缺陷病毒（HIV）。广泛耐药结核病患者每天接受平均5.3±1.3种药物的监督治疗，包括环丝氨酸（一种注射药物）和氟喹诺酮类药物。其中29名患者（60.4%）完成治疗或治愈，而400名耐多药结核病患者（66.3%）（P=0.36）。广泛耐药结核病可以通过门诊治疗在艾滋病毒阴性患者中治愈，即使在那些接受过多次结核病治疗的患者中也是如此。
Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru. A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant. Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [±SD] number of regimens, 4.2±1.9 vs. 3.2±1.6; P<0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4±1.1 vs. 5.3±1.5; P<0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3±1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36). Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis.