Predictors of Treatment Success for Multidrug Resistant Tuberculosis
نویسنده
چکیده
After decades of relatively little attention, the field of tuberculosis (TB) research has drawn much attention in recent years. New anti-TB drugs, those already commercially available and others still in the development pipeline, are among the primary drivers of active research, along with commitments from governmental and non-governmental entities for the global eradication of TB. However, many issues remain to be solved, requiring additional attention, resources, and cooperation. One of the urgent issues regarding TB is multidrug-resistant TB (MDR-TB). MDR-TB is defined as Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin. In 2015, there were estimated 480,000 new cases of MDR-TB, and additional 100,000 cases of RFP-resistant TB. Of the estimated 580,000 patients that are newly eligible for MDR-TB treatment, only 125,000 (20%) were enrolled in treatment programs. Globally, the MDR-TB treatment success rate was 52% in 2013 [1]. In South Korea, 2.7% of new patients with TB and 14% of patients undergoing retreatment of TB were infected with MDR-TB [2], which continues the decrease in incidence since 2012 [3]. For drug-susceptible TB, the standard therapeutic approach includes a combination of four drugs administered for 6-9 months [4]. In patients with MDR-TB, at least five effective anti-TB drugs during intensive phase are recommended, comprising pyrazinamide and four core second-line anti-TB drugs [5]. The suggested timeline of treatment includes the intensive phase for eight months, based on the use of a parenteral agent, a minimum of an additional four months after culture conversion, and a minimum total length of treatment of 18 months after culture conversion. The duration of treatment may be modified according to the patient’s response to therapy [6]. Overall, treatment of MDR-TB is more expensive, longer, and more toxic as compared to the relatively short-course treatment for drug-susceptible TB. In pulmonary TB, conversion of serial sputum culture results from positive to negative is an important indicator of treatment response and infectious state. Culture or smear conversion after 2 months of treatment is widely used as an indicator of treatment effectiveness in drug-susceptible TB.
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عنوان ژورنال:
دوره 48 شماره
صفحات -
تاریخ انتشار 2016