Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis
Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis
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DOI：
10.1093/cid/ciw376
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发表时间：
2016-10-01
影响因子：
11.8
通讯作者：
Vernon, Andrew
中科院分区：
文献类型：
--
作者：
Nahid, Payam;Dorman, Susan E.;Vernon, Andrew
美国胸科学会、美国疾病控制和预防中心和美国传染病学会共同赞助了这一药物敏感结核病治疗指南的制定，该指南也得到了欧洲呼吸学会和美国全国结核病控制协会的认可。来自美国儿科学会、加拿大胸科学会、国际防结核病和肺病联合会以及世界卫生组织的代表也参与了指南的制定。该指南就儿童和成人结核病的临床和公共卫生管理提供了建议，在这些环境中，分枝杆菌培养、分子和表型药敏试验、放射学检查以及其他诊断工具都是常规可用的。对于所有建议，都进行了文献审查，然后由专家委员会根据建议、评估、发展和评价方法的等级进行讨论。鉴于结核病的及时诊断和有效管理对公共卫生的影响，在几乎所有怀疑活动性结核病的情况下都开始经验性的多种药物治疗。其他特征，如合并症的存在、疾病的严重程度和对治疗的反应等影响管理决策。报告就以下方面提出了具体建议：病例管理策略(包括直接观察治疗)、成人和儿童的方案和剂量选择(每日和间歇)、艾滋病毒感染时结核病的治疗(结核病治疗的持续时间和开始抗逆转录病毒治疗的时间)以及肺外疾病的治疗(中枢神经系统、心包等部位)。开发更有效和耐受性更好的药物方案，优化各成分药物的药物暴露，对特殊人群中的结核病进行最佳管理，确定准确的治疗效果生物标志物，以及评估在外地实施方案的新战略，仍然是研究的关键优先领域。有关结核病管理的详细讨论和实践建议，请参阅该文件的全文在线版本。
The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.