Maranetra K N
Division of Respiratory Disease and TB, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chemotherapy. 1999;45 Suppl 2:12-8. doi: 10.1159/000048477.
The prevalence of initial resistance of multidrug-resistant tuberculosis (MDR-TB) to at least isoniazid (INH) and rifampicin (RFP) in Thailand during the period 1993-1997 is reported; in this era, trends for INH + RFP + streptomycin (SM) and ethambutol (EMB), INH + RFP + SM or EMB and MDR-TB were stable. The prevalence of acquired MDR-TB is on a slight downward trend, with the latest level at 22.6%. Recommended management of MDR-TB is outlined and advantages and disadvantages of these guidelines discussed. The role of ofloxacin in MDR-TB is presented, with results from a study performed by the Thailand CDC showing that the percentage of strains resistant to ofloxacin was 4.3%, and to ciprofloxacin was 8.3%. The resistance to both ofloxacin and ciprofloxacin was very low at 1.4%. The percentage of cross-resistance between these fluoroquinolones was also low; 33% resistant to ofloxacin were also resistant to ciprofloxacin and only 17% of those resistant to ciprofloxacin were also resistant to ofloxacin. Results from a clinical trial evaluating ofloxacin with other drugs for MDR-TB are also reported. The regimen comprised ofloxacin 600 mg/day, pyrazinamide (PZA), two to three months of kanamycin (KM) or amikacin (AMK), para-aminosalicylic acid (PAS) plus EMB or thiacetazone. Drugs were given for 18 months. Follow-up was every three months for two years. Preliminary results revealed that the percentage of acquired MDR-TB resistant to specific agents was as follows: 36% resistant to INH and RFP, 23% resistant to INH, RFP plus EMB, 27% resistant to INH, RFP and SM, and 14% resistant to all four of these agents (INH + RFP + SM + EMB). All isolates were sensitive to ofloxacin. At one month of treatment, sputum culture conversion was approximately 25%, climbing to 93% by nine months of treatment. Treatment with ofloxacin in a combined regimen achieved a success rate of 78%. The role of quinolones in preventing TB in MDR-TB contacts is also discussed.
报告了1993 - 1997年期间泰国耐多药结核病（MDR - TB）对至少异烟肼（INH）和利福平（RFP）的初始耐药率；在这个时期，INH + RFP + 链霉素（SM）和乙胺丁醇（EMB）、INH + RFP + SM或EMB以及MDR - TB的趋势是稳定的。获得性MDR - TB的患病率呈轻微下降趋势，最新水平为22.6%。概述了MDR - TB的推荐管理方法，并讨论了这些指南的优缺点。介绍了氧氟沙星在MDR - TB中的作用，泰国疾病控制中心进行的一项研究结果表明，对氧氟沙星耐药的菌株百分比为4.3%，对环丙沙星耐药的为8.3%。对氧氟沙星和环丙沙星两者的耐药率非常低，为1.4%。这些氟喹诺酮类药物之间的交叉耐药百分比也很低；对氧氟沙星耐药的菌株中33%也对环丙沙星耐药，而对环丙沙星耐药的菌株中只有17%也对氧氟沙星耐药。还报告了一项评估氧氟沙星与其他药物联合治疗MDR - TB的临床试验结果。该治疗方案包括每天600毫克氧氟沙星、吡嗪酰胺（PZA）、两到三个月的卡那霉素（KM）或阿米卡星（AMK）、对氨基水杨酸（PAS）加EMB或氨硫脲。药物治疗18个月。随访两年，每三个月一次。初步结果显示，获得性MDR - TB对特定药物耐药的百分比如下：对INH和RFP耐药的为36%，对INH、RFP加EMB耐药的为23%，对INH、RFP和SM耐药的为27%，对所有这四种药物（INH + RFP + SM + EMB）耐药的为14%。所有分离株对氧氟沙星敏感。治疗一个月时，痰培养转阴率约为25%，到治疗九个月时升至93%。氧氟沙星联合治疗方案的成功率为78%。还讨论了喹诺酮类药物在预防MDR - TB接触者感染结核病方面的作用。
