Bouvet Elisabeth
Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Bichat-Claude-Bernard, Paris.
Rev Prat. 2007 Sep 15;57(13):1405-8.
A small proportion of bacilli are naturally resistant to each antituberculous drug. Nevertheless the resistance is not expressed and wild isolates almost never show any resistance. Multidrug resistant tuberculosis is defined as resistance to at least isoniazid and rifampicin. Extensively drug resistant tuberculosis (XDR) is also resistant to more than 3 of the 6 classes of second line drugs including fluoroquinolones and aminoglycosides. The multidrug resistance is increasing in Asia and Eastern Europe. For the moment, the phenomena is rare in France (involving 1,1% of tuberculosis cases with 4% of MDR tested XDR). The best preventive measure consists in a proper use of antituberculosis drugs with combined therapy including at least 3 active drugs during the first 2 months. Another challenge is to be aware of the possiblility of resistance and to prevent further transmission to other patients by airborne isolation measures, particularly in immunosuppressed patients.
一小部分杆菌对每种抗结核药物天然耐药。然而，这种耐药性并未表现出来，野生分离株几乎从不显示任何耐药性。耐多药结核病被定义为至少对异烟肼和利福平耐药。广泛耐药结核病（XDR）还对包括氟喹诺酮类和氨基糖苷类在内的6类二线药物中的3种以上耐药。耐多药现象在亚洲和东欧呈上升趋势。目前，这种现象在法国很少见（涉及1.1%的结核病病例，耐多药检测中广泛耐药的占4%）。最佳预防措施是合理使用抗结核药物，采用联合治疗，在前两个月至少使用3种有效药物。另一个挑战是要意识到耐药的可能性，并通过空气隔离措施防止进一步传播给其他患者，特别是免疫抑制患者。
