WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute/TBNET Secretariat (TuBerculosis Network European Trialsgroup)/Stop TB Italy, Via Roncaccio 16, 21049, Tradate, Italy.
Clin Chest Med. 2009 Dec;30(4):637-65, vii. doi: 10.1016/j.ccm.2009.08.015.
The emergence of multidrug-resistant (MDR) and, more recently, of extensively drug resistant (XDR) strains of Mycobacterium tuberculosis is a real threat to achieve tuberculosis (TB) control and elimination globally. More than 510,000 new cases of MDR-TB occur each year and XDR-TB cases are recognized in every setting where there has been the capacity to detect them, particularly in Eastern Europe. MDR- and XDR-TB control in Europe and the United States are heavily affected by what happens globally, as the majority of cases occurring in these countries originate in high TB-burden areas of the world. Scaling-up of culture- and drug susceptibility testing capacities and the expanded use of high-technology assays for rapid determination of resistance represent the prerequisites to achieve better control of MDR- and XDR-TB. Most cases with MDR- and XDR-TB in Europe and the United States can be treated successfully if well-designed regimens based on available second- and third-line anti-TB drugs are used and surgical options are carefully considered. Nevertheless, the development of new (more effective and less toxic) drugs to treat patients infected by MDR- and XDR-TB strains with or without active disease are urgently needed. Adherence to internationally agreed standards of care and control practices is imperative to achieve TB control.
耐多药（MDR）和最近出现的广泛耐药（XDR）结核分枝杆菌菌株的出现，是实现全球结核病（TB）控制和消除的真正威胁。每年有超过 51 万例新的耐多药 - 结核病例发生，并且在有能力检测到它们的每个环境中都发现了 XDR-TB 病例，特别是在东欧。欧洲和美国的耐多药和广泛耐药结核病控制受到全球发生情况的严重影响，因为这些国家发生的大多数病例都源自世界上结核病负担较重的地区。扩大培养和药敏试验能力以及扩大使用快速确定耐药性的高科技检测方法，是实现更好控制耐多药和广泛耐药结核病的前提条件。如果使用基于现有二线和三线抗结核药物的精心设计方案，并仔细考虑手术选择，欧洲和美国的大多数耐多药和广泛耐药结核病病例都可以成功治疗。然而，迫切需要开发新的（更有效和毒性更低）药物来治疗患有或不患有活动性疾病的耐多药和广泛耐药结核菌株感染的患者。必须遵守国际商定的护理和控制标准，以实现结核病控制。
