University of Florida, College of Medicine, 1600 SW Archer Road, PO Box 100486, Gainesville, FL 32610-0486, USA.
Expert Opin Pharmacother. 2012 Mar;13(4):511-26. doi: 10.1517/14656566.2012.657176. Epub 2012 Feb 15.
In terms of human suffering, tuberculosis has a huge impact on global society, making it arguably the most important infectious disease in history. Despite the devastating impact on society, the tools to fight tuberculosis are very limited. Current standard therapy has been used for over 40 years and threats, such as the HIV epidemic and drug-resistant strains, undermine efforts to control the disease. New drugs are needed to address the challenges faced globally.
Current therapy is briefly reviewed in this paper and then new doses and combinations of existing drugs are presented. New candidate drugs are also discussed, along with the potential benefits and pitfalls of each of the compounds and approaches to therapy.
Despite the need to develop new drugs, the ability of programs to deliver existing therapies must not be neglected. Directly observed therapy and a standard basic level of care for all patients with tuberculosis, regardless of where they reside, is imperative, and will ensure that new drugs and regimens will have the greatest possible impact. New combination regimens, including PA 824 and TMC207, in combination with existing drugs, are very exciting - not only because of their ability to shorten treatment regimens in pan-susceptible cases, but also because they can be used among drug-resistant strains. Although an effective vaccine will probably be necessary to eliminate tuberculosis, new drugs and combination regimens have the potential to save millions of lives before tuberculosis is finally eliminated.
就人类所遭受的苦难而言，结核病对全球社会造成了巨大影响，可以说它是历史上最重要的传染病。尽管它对社会造成了毁灭性的影响，但抗击结核病的手段却非常有限。目前的标准疗法已经使用了 40 多年，而艾滋病病毒的流行和耐药菌株等威胁，正在破坏控制该疾病的努力。需要新的药物来应对全球面临的挑战。
本文简要回顾了当前的治疗方法，然后提出了现有药物的新剂量和新组合。还讨论了新的候选药物，以及每种化合物和治疗方法的潜在益处和陷阱。
尽管需要开发新药，但也不能忽视各项目提供现有疗法的能力。直接观察治疗和为所有结核病患者提供标准的基本护理，无论他们居住在哪里，都是至关重要的，这将确保新的药物和治疗方案能产生最大的影响。新的联合治疗方案，包括 PA-824 和 TMC207 与现有药物联合使用，非常令人兴奋——不仅因为它们有能力缩短泛敏感病例的治疗方案，而且因为它们可以在耐药菌株中使用。虽然有效的疫苗可能是消除结核病所必需的，但新的药物和联合治疗方案有可能在结核病最终被消除之前挽救数百万人的生命。
