Jain Amita, Dixit Pratima
Post Graduate Department of Microbiology, CSM Medical University, Lucknow 226 003, India.
J Biosci. 2008 Nov;33(4):605-16. doi: 10.1007/s12038-008-0078-8.
Drug resistant tuberculosis is a man made problem. While tuberculosis is hundred percent curable, multidrug resistant tuberculosis (MDR-TB) is difficult to treat. Inadequate and incomplete treatment and poor treatment adherence has led to a newer form of drug resistance known as extensively drug resistant tuberculosis (XDR-TB). XDR-TB is defined as tuberculosis caused by Mycobacterium tuberculosis strain, which is resistant to at least rifampicin and isoniazid among the first line anti tubercular drugs (MDR-TB) in addition to resistance to any fluroquinolones and at least one of three injectable second line anti tubercular drugs i.e. amikacin, kanamycin and/or capreomycin. Mismanagement of tuberculosis paves the way to drug resistant tuberculosis. Emergence of XDR-TB is reported world wide. Reported prevalence rates of XDR-TB of total MDR cases are; 6.6% overall worldwide, 6.5% in industrialized countries, 13.6% in Russia and Eastern Europe, 1.5% in Asia, 0.6% in Africa and Middle East and 15.4% in Republic of Korea. Better management and control of tuberculosis specially drug resistant TB by experienced and qualified doctors, access to standard microbiology laboratory,co-morbitidy of HIV and tuberculosis,new anti-TB drug regimens, better diagnostic tests,international standards for second line drugs (SLD)-susceptibility testing,invention of newer anti- tubercular molecules and vaccines and knowing the real magnitude of XDR-TB are some of the important issues to be addressed for effective prevention and management of XDR-TB.
耐药结核病是一个人为造成的问题。虽然结核病百分之百可治愈，但耐多药结核病（MDR-TB）却难以治疗。治疗不充分、不完整以及治疗依从性差导致了一种新的耐药形式，即广泛耐药结核病（XDR-TB）。XDR-TB被定义为由结核分枝杆菌菌株引起的结核病，该菌株除了对任何氟喹诺酮类药物以及三种注射用二线抗结核药物（即阿米卡星、卡那霉素和/或卷曲霉素）中的至少一种耐药外，还对一线抗结核药物（MDR-TB）中的至少利福平及异烟肼耐药。结核病管理不善为耐药结核病铺平了道路。XDR-TB在全球范围内均有报告。报告的XDR-TB在所有MDR病例中的患病率为：全球总体为6.6%，工业化国家为6.5%，俄罗斯和东欧为13.6%，亚洲为1.5%，非洲和中东为0.6%，韩国为15.4%。由经验丰富且资质合格的医生对结核病特别是耐药结核病进行更好的管理和控制、获得标准微生物实验室检测、HIV与结核病的合并感染、新的抗结核药物方案、更好的诊断检测、二线药物（SLD）药敏试验的国际标准、新型抗结核分子和疫苗的发明以及了解XDR-TB的实际严重程度是有效预防和管理XDR-TB需要解决的一些重要问题。
