Vier H, Schaberg T, Gillissen A
Robert-Koch-Klinik, Thoraxzentrum des Klinikums St. Georg, Leipzig.
Pneumologie. 2007 Sep;61(9):606-9. doi: 10.1055/s-2007-980092.
Multi-drug resistant tuberculosis (MDR-Tb), caused by Mycobacterium tuberculosis, is long known, and it is defined to be resistant to both isonizid and rifampicin with or without resistance to other drugs. In addition to MDR-Tb, XDR-Tb (extensively drug-resistant tuberculosis) is resistant to any fluoroquinolone, and at least one of three injectable drugs, in addition to MDR-Tb. For some years these highly resistant Tb have been isolated world wide, which was named XDR 2006. Once no reliable therapy is available, the best way to prevent XDR-Tb is to ensure the efficacy of national TB control programs. The treatment must be in accordance with the results of drug susceptibility testing. Further, there is an urgent need to develop new Tb drugs. However, treatment is made difficult due to specific characteristics of Tb, e. g. the presences of metabolically silent, persistent or dormant bacteria within host lesions, which are not susceptible to antimycobacterial drugs, and its capability to rapidly develop drug resistance. This article informs about the current threat of the emerging XDR-Tb and summarizes possible options to curb with this phenomenon.
耐多药结核病(MDR-Tb)由结核分枝杆菌引起,早已为人所知,其定义为对异烟肼和利福平耐药,且可能对其他药物耐药。除MDR-Tb外,广泛耐药结核病(XDR-Tb)除对MDR-Tb的药物耐药外,还对任何氟喹诺酮类药物以及三种注射用药物中的至少一种耐药。多年来,这些高度耐药的结核病在全球范围内被分离出来,在2006年被命名为XDR。一旦没有可靠的治疗方法,预防XDR-Tb的最佳方法是确保国家结核病控制项目的有效性。治疗必须根据药敏试验结果进行。此外,迫切需要开发新的抗结核药物。然而,由于结核病的特殊特性,治疗变得困难,例如宿主病变内存在代谢静止、持续或休眠的细菌,这些细菌对抗结核药物不敏感,且其具有迅速产生耐药性的能力。本文介绍了新出现的XDR-Tb的当前威胁,并总结了遏制这种现象的可能选择。