Family Medicine, Resurrection Medical Center, Chicago, IL, USA.
Am J Ther. 2011 Jul;18(4):e101-12. doi: 10.1097/MJT.0b013e3181c3509c.
Tuberculosis continues to be a global threat. Efforts to eradicate this disease are hampered by the long course and potential toxicity of currently available treatment regimens, the increasing prevalence of tuberculosis-HIV coinfection, the evolution of drug resistant organisms, and the lack of a highly effective vaccine. Recent studies have suggested methods to improve the cost effectiveness of existing treatment strategies. Decreasing the relapse rate among high-risk individuals by extending therapy can be balanced by the cost savings of self-administered therapy for low-risk individuals. For the first time in over 30 years, new medications are flowing through the drug discovery pipeline. New agents with activity against slowly dividing bacilli have the potential to shorten the duration of therapy. Many have a more favorable side-effect profile than currently available medications. And even extensively drug-resistant organisms will be susceptible to these secret weapons. The fully sequenced genome of Mycobacterium tuberculosis has been exploited to develop safer and more effective candidate vaccines. Highly immunogenic mycobacterial fragments, revved-up versions of the existing vaccine, and toned-down versions of M. tuberculosis are all in various phases of clinical testing. This expanded arsenal has the potential to deliver a fatal blow to one of humanity's greatest enemies.
结核病仍然是一个全球性的威胁。目前可用的治疗方案疗程长且潜在毒性大、结核病-艾滋病病毒合并感染的患病率不断增加、耐药生物体的进化以及缺乏高效疫苗，这些因素都阻碍了消灭这种疾病的努力。最近的研究提出了一些方法来提高现有治疗策略的成本效益。通过延长治疗时间来降低高危人群的复发率，可以通过为低危人群提供自我管理治疗来节省成本。30 多年来，首次有新药物通过药物发现管道进入市场。对缓慢分裂杆菌有活性的新型药物有可能缩短治疗时间。许多药物的副作用比目前可用的药物更有利。甚至对广泛耐药的生物体也将对这些秘密武器敏感。结核分枝杆菌的全基因组序列已被用于开发更安全、更有效的候选疫苗。高免疫原性分枝杆菌片段、现有疫苗的强化版本以及结核分枝杆菌的弱化版本都处于不同的临床测试阶段。这个扩展的武器库有可能对人类最大的敌人之一造成致命打击。
