Iseman M D
Clinical Mycobacteriology Service, The Division of Infectious Diseases, National Jewish Medical and Research Center, Denver, CO 80206, USA.
Chemotherapy. 1999;45 Suppl 2:34-40. doi: 10.1159/000048480.
Drug-resistant tuberculosis fundamentally reflects inadequate chemotherapy. To prevent increases in the prevalence of resistance, physician education and more structured treatment programs are needed. In one recent series, 80% of patients with multidrug-resistant tuberculosis (MDR-TB) had been previously managed with clear breaches of standard practice. These errors included adding a single drug to a failing regimen, failing to identify initial or acquired resistance, using an inadequate regimen, and not recognizing (and coping with) non-adherence to therapy. Both medical and surgical management should be considered in optimizing treatment of patients with MDR-TB. Optimal treatment strategies for MDR-TB are outlined in this paper. The use of susceptibility testing is strongly advised, but in situations where such laboratory services are not available, empirical management regimens are discussed.
耐药结核病从根本上反映出化疗不足。为防止耐药率上升，需要对医生进行教育并制定更规范的治疗方案。在最近的一组病例中，80%的耐多药结核病（MDR-TB）患者此前接受的治疗明显违反了标准做法。这些错误包括在治疗失败的方案中添加单一药物、未能识别初始或获得性耐药、使用的方案不充分以及未认识到（并应对）治疗依从性差的问题。在优化耐多药结核病患者的治疗时，应同时考虑药物治疗和手术治疗。本文概述了耐多药结核病的最佳治疗策略。强烈建议进行药敏试验，但在没有此类实验室服务的情况下，也讨论了经验性治疗方案。
