Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin.
Dtsch Arztebl Int. 2010 Jan;107(1-2):10-9. doi: 10.3238/arztebl.2010.0010. Epub 2010 Jan 7.
Although the incidence of tuberculosis (TB) in Germany is now declining, the world as a whole faces the threat of a catastrophe that will also affect the industrialized nations. The main reason, aside from TB/HIV co-infection, is the increase of resistant TB strains. The situation is already serious because of the spread of multidrug-resistant TB, i.e., TB that is resistant to the two most important antituberculous drugs, and is being further aggravated by resistance to second-line drugs as well.
Selective review of the literature.
There are an estimated half a million cases of multidrug-resistant TB worldwide, and so-called extensively resistant TB (XDR-TB), with additional resistance to defined second-line drugs, is now prevalent in more than 45 countries. An accurate assessment of the situation is hampered by a widespread lack of laboratory capacity and/or proper surveillance. The problem is mainly due to inappropriate treatment, which may have many causes, but is theoretically avoidable. Aside from programmatic weaknesses, a lack of diagnostic and therapeutic tools causes difficulties in many countries.
Only rapid and internationally concerted action, combined with intensified research efforts and the support of the affected nations, will be able to prevent the development of a situation that will no longer be manageable even with 21(st)-century technology.
尽管德国的结核病（TB）发病率正在下降，但全球仍面临着一场灾难的威胁，这场灾难也将影响到工业化国家。除了 TB/HIV 合并感染外，主要原因是耐药结核菌株的增加。由于耐多药结核病（即对两种最重要的抗结核药物具有耐药性的结核病）的传播，情况已经很严重，而且对二线药物的耐药性也在进一步加剧。
对文献进行选择性回顾。
全球估计有 50 万例耐多药结核病病例，所谓的广泛耐药结核病（XDR-TB），即对特定二线药物也具有耐药性，现在在 45 个以上的国家流行。由于实验室能力和/或适当监测的广泛缺乏，对这一情况的准确评估受到阻碍。该问题主要归因于不适当的治疗，这可能有多种原因，但在理论上是可以避免的。除了方案上的弱点外，诊断和治疗工具的缺乏在许多国家都造成了困难。
只有迅速采取国际协调行动，加强研究努力，并得到受影响国家的支持，才能防止出现即使采用 21 世纪技术也将无法控制的局面。
