Seung Kwonjune J, Keshavjee Salmaan, Rich Michael L
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts 02115 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115 Partners In Health, Boston, Massachusetts 02215.
Cold Spring Harb Perspect Med. 2015 Apr 27;5(9):a017863. doi: 10.1101/cshperspect.a017863.
The continuing spread of drug-resistant tuberculosis (TB) is one of the most urgent and difficult challenges facing global TB control. Patients who are infected with strains resistant to isoniazid and rifampicin, called multidrug-resistant (MDR) TB, are practically incurable by standard first-line treatment. In 2012, there were approximately 450,000 new cases and 170,000 deaths because of MDR-TB. Extensively drug-resistant (XDR) TB refers to MDR-TB strains that are resistant to fluoroquinolones and second-line injectable drugs. The main causes of the spread of resistant TB are weak medical systems, amplification of resistance patterns through incorrect treatment, and transmission in communities and facilities. Although patients harboring MDR and XDR strains present a formidable challenge for treatment, cure is often possible with early identification of resistance and use of a properly designed regimen. Community-based programs can improve treatment outcomes by allowing patients to be treated in their homes and addressing socioeconomic barriers to adherence.
耐多药结核病的持续传播是全球结核病控制面临的最紧迫、最困难的挑战之一。感染对异烟肼和利福平耐药菌株的患者，即耐多药结核病患者，几乎无法通过标准一线治疗治愈。2012年，因耐多药结核病出现了约45万新病例和17万例死亡。广泛耐药结核病是指对氟喹诺酮类药物和二线注射药物耐药的耐多药结核病菌株。耐药结核病传播的主要原因是医疗系统薄弱、因治疗不当导致耐药模式扩大以及在社区和医疗机构中的传播。尽管携带耐多药和广泛耐药菌株的患者在治疗上面临巨大挑战，但通过早期识别耐药性并使用精心设计的治疗方案，通常可以治愈。基于社区的项目可以通过让患者在家中接受治疗并消除影响依从性的社会经济障碍来改善治疗效果。
