Management of multidrug-resistant tuberculosis
Management of multidrug-resistant tuberculosis
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DOI：
10.1159/000048476
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发表时间：
1999-01-01
期刊：
影响因子：
3.3
通讯作者：
Iseman, MD
中科院分区：
文献类型：
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作者：
Iseman, MD
耐药结核病（TB）最初是治疗不充分的产物;这可能涉及不遵守治疗，中断药物供应或不适当的处方。通过重复这一过程，患者可能会相继获得对几种药物的耐药性。主要药物活性的丧失极大地影响了治疗过程;最大的问题是对异烟肼和利福平的耐药性，即所谓的“耐多药结核病”（MDR-TB）。最近的证据表明，耐多药结核病正在传染给其他人，特别是艾滋病毒感染者/艾滋病患者。耐多药结核病流行蔓延的其他情况包括医院和监狱。世卫组织最近的一项调查发现，在世界若干地区，耐多药结核病已达到不祥的水平。耐多药结核病的治疗需要使用耐受性差的二线药物，这些药物往往有毒，治疗时间必须延长至两年。对于大多数一线药物已失去耐药性的晚期need疾病患者，可能需要切除手术来实现治愈。
Drug-resistant tuberculosis (TB) originally is the product of inadequate therapy; this may entail noncompliance with treatment, interrupted drug supplies, or inappropriate prescription. Patients may sequentially acquire resistance to several drugs through repetition of this process. Loss of activity of the major drugs greatly compromises the treatment process; most problematic is resistance to both isoniazid and rifampicin, so-called 'multidrug-resistant tuberculosis' (MDR-TB). Recent evidence indicates that MDR-TB is being transmitted to others, and particularly to persons with HIV infection/AIDS. Other situations in which epidemic spread of MDR-TB occurs include hospitals and prisons. In several areas of the world, ominous levels of MDR-TB have been identified in a recent WHO survey. Treatment of MDR-TB entails the use of poorly tolerated, second-line medications that are often toxic, and the duration of treatment must be extended to the range of two years. Resectional surgery may be required to effect cures in patients with advanced need disease in which most of the first-line agents have been lost to resistance.