Management of difficult multidrug‐resistant tuberculosis and extensively drug‐resistant tuberculosis: Update 2012
Identifieur interne : 002E59 ( Main/Exploration ); précédent : 002E58; suivant : 002E60Management of difficult multidrug‐resistant tuberculosis and extensively drug‐resistant tuberculosis: Update 2012
Auteurs : Kwok Hiu Chang [Hong Kong] ; Wing-Wai Yew [République populaire de Chine]Source :
- Respirology [ 1323-7799 ] ; 2013-01.
Descripteurs français
- Wicri :
- topic : Soins de santé, Soins palliatifs, Santé publique.
English descriptors
- KwdEn :
- Adjunctive, Adjunctive surgery, Agents chemother, Airborne infection control, Antimicrob, Antiretroviral, Antiretroviral therapy, Asian society, Assay, Authors respirology, Bacillary, Bacillary resistance, Chang, Chemother, Chemotherapy, Chest service, Clin, Cohort, Crit, Cure rate, Diagnostic delay, Dosing, Drug resistance, Drug susceptibility, Drugresistant, Drugresistant tuberculosis, Early bactericidal activity, Engl, Food incentives, Global, Global epidemic, Guideline, Health care, High cure rates, High prevalence, Hong kong, Household contacts, Human virus, Immunotherapy, Infection control, Injectable, Injectable agents, Injectable drugs, Isoniazid, Lancet, Leung, Line probe assay, Linezolid, Liquid medium, Management strategies, Mathematical model, Microscopic observation, Molecular assays, Multidrugresistant, Multidrugresistant tuberculosis, Murine model, Mycobacterium, Mycobacterium tuberculosis, Newer generation, Nitrate reductase assay, Palliative care, Plo, Policy statement, Preventive strategies, Preventive treatment, Private practitioners, Programmatic management, Programme, Public health, Pulmonary resection, Pulmonary tuberculosis, Pyrazinamide, Pyrazinamide resistance, Randomized, Rapid culture, Regimen, Resection, Resistant tuberculosis, Respir, Respirology, Retrospective, Retrospective cohort study, Retrospective study, Rifampicin, Sputum, Surg, Susceptibility, Systematic review, Thorac, Treatment adherence, Treatment outcomes, Treatment success, Tuberc, Tuberculosis, Tuberculosis care, Tuberculosis control, Tuberculosis patients, Tuberculosis treatment, Uoroquinolone, Uoroquinolones, World health organization.
- Teeft :
- Adjunctive, Adjunctive surgery, Agents chemother, Airborne infection control, Antimicrob, Antiretroviral, Antiretroviral therapy, Asian society, Assay, Authors respirology, Bacillary, Bacillary resistance, Chang, Chemother, Chemotherapy, Chest service, Clin, Cohort, Crit, Cure rate, Diagnostic delay, Dosing, Drug resistance, Drug susceptibility, Drugresistant, Drugresistant tuberculosis, Early bactericidal activity, Engl, Food incentives, Global, Global epidemic, Guideline, Health care, High cure rates, High prevalence, Hong kong, Household contacts, Human virus, Immunotherapy, Infection control, Injectable, Injectable agents, Injectable drugs, Isoniazid, Lancet, Leung, Line probe assay, Linezolid, Liquid medium, Management strategies, Mathematical model, Microscopic observation, Molecular assays, Multidrugresistant, Multidrugresistant tuberculosis, Murine model, Mycobacterium, Mycobacterium tuberculosis, Newer generation, Nitrate reductase assay, Palliative care, Plo, Policy statement, Preventive strategies, Preventive treatment, Private practitioners, Programmatic management, Programme, Public health, Pulmonary resection, Pulmonary tuberculosis, Pyrazinamide, Pyrazinamide resistance, Randomized, Rapid culture, Regimen, Resection, Resistant tuberculosis, Respir, Respirology, Retrospective, Retrospective cohort study, Retrospective study, Rifampicin, Sputum, Surg, Susceptibility, Systematic review, Thorac, Treatment adherence, Treatment outcomes, Treatment success, Tuberc, Tuberculosis, Tuberculosis care, Tuberculosis control, Tuberculosis patients, Tuberculosis treatment, Uoroquinolone, Uoroquinolones, World health organization.
Abstract
Multidrug‐resistant (MDR) tuberculosis (TB) denotes bacillary resistance to at least isoniazid and rifampicin. Extensively drug‐resistant (XDR) TB is MDR‐TB with additional bacillary resistance to any fluoroquinolone and at least one second‐line injectable drugs. Rooted in inadequate TB treatment and compounded by a vicious circle of diagnostic delay and improper treatment, MDR‐TB/XDR‐TB has become a global epidemic that is fuelled by poverty, human immunodeficiency virus (HIV) and neglect of airborne infection control. The majority of MDR‐TB cases in some settings with high prevalence of MDR‐TB are due to transmission of drug‐resistant bacillary strains to previously untreated patients. Global efforts in controlling MDR‐TB/XDR‐TB can no longer focus solely on high‐risk patients. It is difficult and costly to treat MDR‐TB/XDR‐TB. Without timely implementation of preventive and management strategies, difficult MDR‐TB/XDR‐TB can cripple global TB control efforts. Preventive strategies include prompt diagnosis with adequate TB treatment using the directly observed therapy, short‐course (DOTS) strategy and drug‐resistance programmes, airborne infection control, preventive treatment of TB/HIV, and optimal use of antiretroviral therapy. Management strategies for established cases of difficult MDR‐TB/XDR‐TB rely on harnessing existing drugs (notably newer generation fluoroquinolones, high‐dose isoniazid, linezolid and pyrazinamide with in vitro activity) in the best combinations and dosing schedules, together with adjunctive surgery in carefully selected cases. Immunotherapy may also have a role in the future. New diagnostics, drugs and vaccines are required to meet the challenge, but science alone is insufficient. Difficult MDR‐TB/XDR‐TB cannot be tackled without achieving high cure rates with quality DOTS and beyond, and concurrently addressing poverty and HIV.
Url:
DOI: 10.1111/j.1440-1843.2012.02257.x
Affiliations:
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<front><div type="abstract" xml:lang="en">Multidrug‐resistant (MDR) tuberculosis (TB) denotes bacillary resistance to at least isoniazid and rifampicin. Extensively drug‐resistant (XDR) TB is MDR‐TB with additional bacillary resistance to any fluoroquinolone and at least one second‐line injectable drugs. Rooted in inadequate TB treatment and compounded by a vicious circle of diagnostic delay and improper treatment, MDR‐TB/XDR‐TB has become a global epidemic that is fuelled by poverty, human immunodeficiency virus (HIV) and neglect of airborne infection control. The majority of MDR‐TB cases in some settings with high prevalence of MDR‐TB are due to transmission of drug‐resistant bacillary strains to previously untreated patients. Global efforts in controlling MDR‐TB/XDR‐TB can no longer focus solely on high‐risk patients. It is difficult and costly to treat MDR‐TB/XDR‐TB. Without timely implementation of preventive and management strategies, difficult MDR‐TB/XDR‐TB can cripple global TB control efforts. Preventive strategies include prompt diagnosis with adequate TB treatment using the directly observed therapy, short‐course (DOTS) strategy and drug‐resistance programmes, airborne infection control, preventive treatment of TB/HIV, and optimal use of antiretroviral therapy. Management strategies for established cases of difficult MDR‐TB/XDR‐TB rely on harnessing existing drugs (notably newer generation fluoroquinolones, high‐dose isoniazid, linezolid and pyrazinamide with in vitro activity) in the best combinations and dosing schedules, together with adjunctive surgery in carefully selected cases. Immunotherapy may also have a role in the future. New diagnostics, drugs and vaccines are required to meet the challenge, but science alone is insufficient. Difficult MDR‐TB/XDR‐TB cannot be tackled without achieving high cure rates with quality DOTS and beyond, and concurrently addressing poverty and HIV.</div>
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