School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States of America.
Bull World Health Organ. 2012 Jan 1;90(1):63-6. doi: 10.2471/BLT.11.092320. Epub 2011 Nov 24.
The category II retreatment regimen for management of tuberculosis in previously treated patients was first introduced in the early 1990s. It consists of 8 months of total therapy with the addition of streptomycin to standard first-line medications. A review of 6500 patients on category II therapy in Georgia showed poor outcomes and high rates of streptomycin resistance.
The National Tuberculosis Program used an evidence-based analysis of national data to convince policy-makers that category II therapy should be eliminated from national guidelines in Georgia.
The World Health Organization tuberculosis case-notification rate in Georgia is 102 per 100,000 population. All patients receive culture and drug susceptibility testing as a standard part of tuberculosis diagnosis. In 2009, routine surveillance found multidrug-resistant tuberculosis in 10.6% of newly diagnosed patients and 32.5% of previously treated cases.
Category II retreatment regimen is no longer used in Georgia. Treatment is guided by results of drug susceptibility testing--using rapid, molecular tests where possible--for all previously treated tuberculosis patients.
There was little resistance to policy change because the review was initiated and led by the National Tuberculosis Program. This experience can serve as a successful model for other countries to make informed decisions about the use of category II therapy.
最初在 20 世纪 90 年代初引入了用于治疗既往治疗患者结核病的 II 类复治方案。它包括 8 个月的全程治疗，在标准一线药物中加入链霉素。对格鲁吉亚 6500 名接受 II 类治疗的患者进行的审查显示，治疗结果不佳，链霉素耐药率很高。
国家结核病规划利用国家数据的循证分析，说服决策者在格鲁吉亚从国家指南中删除 II 类治疗。
世界卫生组织在格鲁吉亚的结核病例报告率为每 10 万人 102 例。所有患者都接受培养和药敏试验，作为结核病诊断的标准部分。2009 年，常规监测发现新诊断患者中有 10.6%和既往治疗病例中有 32.5%患有耐多药结核病。
格鲁吉亚不再使用 II 类复治方案。所有既往治疗的结核病患者的治疗均根据药敏试验结果（尽可能使用快速、分子检测）进行指导。
由于国家结核病规划发起并领导了审查，因此对政策变更的阻力很小。这一经验可以为其他国家提供成功的模式，以便就使用 II 类治疗做出明智的决策。
