Prasad Rajendra
Department of Pulmonary Medicine, C.S.M. Medical University, Lucknow.
Indian J Tuberc. 2010 Oct;57(4):180-91.
Multi Drug Resistant Tuberculosis (MDR-TB) and Extensively Drug Resistant Tuberculosis (XDR-TB) are posing a threat to the control of tuberculosis. The first WHO-IUATLD antituberculosis drug resistance surveillance carried out in 1994 in 35 countries reported the median prevalence of primary and acquired multi drug resistance as 1.4% and 13% respectively. Subsequently, second, third and fourth WHO-IUATLD global drug resistance surveillances were carried out in 1996-99, 1999-2002 and 2002-2007 respectively. Based on drug resistance information from 114 countries, the proportion of MDR-TB among all cases was estimated for countries with no survey information. It was estimated that 4,89,139 cases of MDR-TB emerged in 2006. China and India carry approximately 50% of the global burden. 35 countries and two Special Administrative Regions (SARs) reported data on XDR-TB for the first time in 2006. Multidrug and extensively drug-resistant TB 2010 Global report on Surveillance and response estimated that 4,40,000 cases of MDR-TB emerged globally in 2008 and caused an estimated 1,50,000 deaths. 5.4% of MDR-TB cases were found to have XDR-TB. To date, a cumulative total of 58 countries have confirmed at least one case of XDR-TB. M/XDR-TB is a man-made problem and its emergence can be prevented by prompt diagnosis and effective use of first line drugs in every new patient. The DOTS Plus proposed by WHO highlights the comprehensive management strategy to control MDR-TB. Laboratory services for adequate and timely diagnosis of M/XDR-TB must be strengthened and programmatic management of M/XDR-TB must be scaled up as per target set by global plan. Proper use of second-line drugs must be ensured to cure existing MDR-TB, to reduce its transmission and to prevent XDR-TB. Sound infection control measures to avoid further transmission of M/XDR-TB and research towards development of new diagnostics, drugs and vaccines should be promoted to control M/XDR-TB.
耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）对结核病控制构成威胁。1994年在35个国家开展的首次世卫组织-国际防痨和肺部疾病联盟抗结核药物耐药性监测报告称，原发性和获得性耐多药的中位数患病率分别为1.4%和13%。随后，分别于1996 - 1999年、1999 - 2002年和2002 - 2007年开展了第二次、第三次和第四次世卫组织-国际防痨和肺部疾病联盟全球耐药性监测。根据114个国家的耐药性信息，对没有调查信息的国家估计了所有病例中耐多药结核病的比例。据估计，2006年出现了489139例耐多药结核病病例。中国和印度承担了全球约50%的负担。35个国家和两个特别行政区（SARs）于2006年首次报告了广泛耐药结核病的数据。《2010年耐多药和广泛耐药结核病全球监测与应对报告》估计，2008年全球出现了440000例耐多药结核病病例，估计导致150000人死亡。发现5.4%的耐多药结核病病例患有广泛耐药结核病。迄今为止，累计共有58个国家确认至少有一例广泛耐药结核病病例。耐多药/广泛耐药结核病是一个人为问题，通过对每一位新患者进行及时诊断和有效使用一线药物可以预防其出现。世卫组织提出的强化治疗（DOTS Plus）突出了控制耐多药结核病的综合管理策略。必须加强实验室服务，以便对耐多药/广泛耐药结核病进行充分和及时的诊断，并且必须按照全球计划设定的目标扩大耐多药/广泛耐药结核病的规划管理。必须确保正确使用二线药物，以治愈现有的耐多药结核病，减少其传播并预防广泛耐药结核病。应推广合理的感染控制措施，以避免耐多药/广泛耐药结核病的进一步传播，并推动开展关于开发新诊断方法、药物和疫苗的研究，以控制耐多药/广泛耐药结核病。
