Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Infect Dis. 2010 May 15;50 Suppl 3:S195-200. doi: 10.1086/651491.
Over the past 7 decades, Mycobacterium tuberculosis has developed resistance to virtually every new drug used to treat tuberculosis, resulting recently in the global emergence of extensively drug-resistant tuberculosis. In an individual, treatment with a single new drug results in acquired drug resistance within weeks to months. On a population basis, the pattern is just as consistent. After a new drug is introduced, drug-resistant cases or case series are reported within months to years, typically leading to focused surveys, and within several years, dramatic outbreaks with extraordinary mortality occur. Invariably, such outbreaks prove to be the tip of the iceberg. Incomplete and delayed diagnoses, drug costs, and drug supplies are frequently implicated. With new drugs and new diagnostics on the horizon, we must develop new ways of incorporating them into public health practice, basing treatment on rapid drug-susceptibility tests, ensuring that effective drugs are always used in combination, and making these drug available to persons who need them.
在过去的 70 年里，结核分枝杆菌对用于治疗结核病的几乎每一种新药都产生了耐药性，最近导致了广泛耐药结核的全球出现。在个体中，单一新型药物的治疗会在数周到数月内产生获得性耐药。从人群基础上看，情况同样一致。在引入新药后，数月至数年内会报告耐药病例或耐药病例系列，通常会进行针对性调查，而在数年内，会出现死亡率极高的戏剧性暴发。这种暴发无一例外地证明只是冰山一角。不完整和延迟的诊断、药物费用和药物供应经常是原因所在。随着新型药物和新型诊断方法的出现，我们必须开发新方法将其纳入公共卫生实践，基于快速药物敏感性测试进行治疗，确保始终联合使用有效的药物，并使这些药物提供给需要的人。
