Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY 10467, USA.
Lancet. 2010 May 22;375(9728):1830-43. doi: 10.1016/S0140-6736(10)60410-2.
Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of the estimated 440,000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth were treated according to WHO standards. Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis. Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale.
尽管在降低全球耐多药结核病发病率方面取得了进展，但在过去十年中，耐多药（MDR）和广泛耐药（XDR）结核病的出现威胁到了这些进展。然而，各国的反应速度太慢。在 2008 年估计发生的 44 万例耐多药结核病病例中，只有 7%被发现并向世卫组织报告。在这些病例中，只有五分之一按照世卫组织的标准进行了治疗。虽然目前的诊断技术和药物可以治疗耐多药和广泛耐药结核病，但治疗过程比治疗敏感结核病要复杂得多，费用也高得多，失败率和死亡率也更高。尽管如此，一些国家提供了如何在十年内利用现有技术扭转耐多药结核病流行的例子。需要在实验室能力、感染控制、结核病控制规划的实施以及敏感和耐药疾病的治疗方案方面取得重大改进，同时需要大规模扩大耐多药和广泛耐药结核病的诊断和治疗，以防止耐药菌株成为结核病的主要形式。在未来几年，新的诊断检测和药物可能会问世，这将有助于加快耐多药和广泛耐药结核病的控制。同样重要的是，特别是在印度、中国和俄罗斯等负担最重的国家，需要承诺控制结核病，包括改善国家政策和卫生系统，消除治疗的财政障碍，鼓励合理用药，并建立必要的基础设施，以便在国家范围内管理耐多药结核病。
