Treatment of Drug-Resistant Tuberculosis An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline
Treatment of Drug-Resistant Tuberculosis An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline
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DOI：
10.1164/rccm.201909-1874st
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发表时间：
2019-11-15
影响因子：
24.7
通讯作者：
Seaworth, Barbara
中科院分区：
文献类型：
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作者：
Nahid, Payam;Mase, Sundari R.;Seaworth, Barbara
背景：美国胸科学会、美国疾病控制与预防中心、欧洲呼吸学会和美国传染病学会联合发起了这一新的耐药结核病（DR-TB）治疗实践指南。该文件包括关于治疗耐多药结核病 (MDR-TB) 以及耐异烟肼但对利福平敏感的结核病的建议。 方法：本指南使用了已发表的系统评价、荟萃分析和新的个体患者数据荟萃分析，这些数据来自 25 个国家的 50 项研究中的 12,030 名患者，这些患者已确诊为利福平耐药结核病。荟萃分析方法包括倾向评分匹配以减少混杂因素。每项建议均由专家委员会根据建议分级、评估、开发和评估 (GRADE) 方法进行讨论，筛选利益冲突。结果：解决了 21 项人群、干预、比较和结果问题，生成 25 项基于 GRADE 的建议。证据的确定性被认为非常低，因为数据来自观察性研究，随访结果显着丢失，并且比较组之间的背景治疗方案不平衡。描述了管理耐多药结核病的良好做法。在证据审查的基础上，还提供了建立耐多药结核病治疗方案的临床策略工具。结论：对治疗方案中药物的选择和数量、强化和持续阶段的持续时间以及注射药物在耐多药结核病中的作用提出了新的建议。在这些建议的基础上，可以制定有效的耐多药结核病全口服治疗方案。还就手术在耐多药结核病治疗中的作用、耐多药结核病接触者的治疗以及耐异烟肼结核病的治疗提供了建议。
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.