Management of drug-resistant tuberculosis

Date
2010
Authors
Chiang C.-Y.
Schaaf H.S.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Drug-resistant tuberculosis (DR-TB) in adults is either acquired due to poor treatment management or transmitted from infectious DR-TB cases, while children mainly have transmitted disease. Diagnosis of DR-TB relies on drug susceptibility testing (DST), which is not routinely performed in high tuberculosis (TB) burden settings. The Category II retreatment regimen is inadequate for Category I failures if multidrug-resistant TB (MDR-TB) is present. Where possible, DST should be performed for Category I failures and other patients with a high risk of DR-TB. Fluoroquinolones (FQs) should be used with caution in the treatment of mono- and polyresistant TB. Modification of regimens for mono- and polyresistance is prone to error if DST results are not reliable or if there is possible additional drug resistance due to further drug exposure. While standardised treatment is feasible for MDR-TB patients never previously treated with second-line drugs, a different strategy is required for those MDRTB patients who have previously been treated with second-line drugs. Sputum conversion, adverse effects and adherence to MDR-TB treatment should be monitored closely. The presence of FQ resistance prior to MDR-TB treatment poses a serious challenge. To prevent the development of extensively drug-resistant TB, strategies to protect the FQs, the most important second-line agents, need to be developed. Clinical trials assessing MDR-TB treatment regimens are urgently needed. © 2010 The Union.
Description
Keywords
amikacin; aminosalicylic acid; amoxicillin plus clavulanic acid; capreomycin; cilastatin plus imipenem; clarithromycin; clofazimine; creatinine; cycloserine; ethambutol; ethionamide; hemoglobin; isoniazid; kanamycin; levofloxacin; liver enzyme; moxifloxacin; ofloxacin; potassium; protionamide; pyrazinamide; rifampicin; streptomycin; terizidone; thyrotropin; tuberculostatic agent; unindexed drug; add on therapy; arthralgia; bacterium culture; childhood disease; clinical trial; creatinine blood level; depression; disease association; disease transmission; drug classification; drug dose escalation; drug exposure; drug megadose; drug resistant tuberculosis; drug sensitivity; drug tolerability; drug withdrawal; enzyme blood level; extensively drug resistant tuberculosis; follow up; gastrointestinal symptom; growth curve; headache; health program; hemoglobin blood level; hepatitis; human; Human immunodeficiency virus infection; hypokalemia; hypomagnesemia; hypothyroidism; infection risk; injection site pain; irritability; laboratory test; leukocyte count; mental disease; microbiological examination; multidrug resistant tuberculosis; nephrotoxicity; neurologic disease; ototoxicity; parent counseling; patient monitoring; peripheral neuropathy; potassium blood level; priority journal; review; seizure; short course therapy; side effect; sputum culture; sputum examination; suicidal ideation; thrombocyte count; thyrotropin blood level; treatment duration; treatment failure; treatment outcome; turnover time; weight gain; Antitubercular Agents; Diagnosis, Differential; Drug Resistance, Bacterial; Humans; Incidence; Mycobacterium tuberculosis; Tuberculosis, Multidrug-Resistant
Citation
International Journal of Tuberculosis and Lung Disease
14
6