Sotgiu Giovanni, Migliori Giovanni Battista
Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, via Roncaccio 16, 21049 Tradate (VA), Italy.
Pulm Pharmacol Ther. 2015 Jun;32:144-8. doi: 10.1016/j.pupt.2014.04.006. Epub 2014 Apr 30.
Multi-drug resistant tuberculosis (MDR-TB) is caused by Mycobacterium tuberculosis strains resistant to at least two of the most effective anti-tuberculosis drugs (i.e., isoniazid and rifampicin). Therapeutic regimens based on second- and third-line anti-tuberculosis medicines showed poor efficacy, safety, and tolerability profiles. It was estimated that in 2012 the multi-drug resistant tuberculosis incidence ranged from 300,000 to 600,000 cases, mainly diagnosed in the Eastern European and Central Asian countries. The highest proportion of cases is among individuals previously exposed to anti-tuberculosis drugs. Three main conditions can favour the emergence and spread of multi-drug resistant tuberculosis: the poor implementation of the DOTS strategy, the shortage or the poor quality of the anti-tuberculosis drugs, and the poor therapeutic adherence of the patients to the prescribed regimens. Consultation with tuberculosis experts (e.g., consilium) is crucial to tailor the best anti-tuberculosis therapy. New therapeutic options are necessary: bedaquiline and delamanid seem promising drugs; in particular, during the development phase they demonstrated a protective effect against the emergence of further resistances towards the backbone drugs. In the recent past, other antibiotics have been administered off-label: the most relevant efficacy, safety, and tolerability profile was proved in linezolid-, meropenem/clavulanate-, cotrimoxazole-containing regimens. New research and development activities are needed in the diagnostic, therapeutic, preventive fields.
耐多药结核病（MDR-TB）由结核分枝杆菌菌株引起，这些菌株对至少两种最有效的抗结核药物（即异烟肼和利福平）耐药。基于二线和三线抗结核药物的治疗方案显示出疗效、安全性和耐受性较差。据估计，2012年耐多药结核病发病率在30万至60万例之间，主要在东欧和中亚国家被诊断出来。病例比例最高的是那些先前接触过抗结核药物的个体。有三个主要条件有利于耐多药结核病的出现和传播：直接观察短程治疗（DOTS）策略实施不力、抗结核药物短缺或质量差，以及患者对规定治疗方案的治疗依从性差。咨询结核病专家（如会诊）对于制定最佳抗结核治疗方案至关重要。需要新的治疗选择：贝达喹啉和地拉曼德似乎是有前景的药物；特别是在研发阶段，它们对主干药物进一步耐药的出现表现出保护作用。最近，其他抗生素也被超适应症使用：在含利奈唑胺、美罗培南/克拉维酸、复方新诺明的治疗方案中，已证明其具有最相关的疗效、安全性和耐受性。在诊断、治疗、预防领域需要开展新的研发活动。
