Sydney Medical School, Room 574 Blackburn Building, University of Sydney, Sydney, 2006, Australia.
Sydney Medical School, Room 574 Blackburn Building, University of Sydney, Sydney, 2006, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
Int J Infect Dis. 2017 Mar;56:68-76. doi: 10.1016/j.ijid.2016.11.006. Epub 2016 Nov 18.
Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and individuals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each individual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.
全球约有三分之一的人口可能患有潜伏性结核感染（LTBI），这是一种无症状的免疫状态，会增加随后罹患结核病（TB）的风险。如果要实现终止结核病战略，有效治疗 LTBI 将是至关重要的。本综述评估了针对耐药和敏感菌引起的 LTBI 进行预防性抗生素治疗的有效性证据。总结了当前国家和国际预防治疗指南，以及正在评估预防耐药性结核病方案的随机试验。最有可能从 LTBI 筛查和治疗中获益的人群包括结核病患者的密切接触者（特别是 5 岁以下儿童）和存在严重免疫功能损害的个体。必须仔细权衡每位患者的治疗风险和获益。电子决策支持工具为临床医生帮助患者做出知情决策提供了一种方法。模型研究表明，扩大预防性治疗的使用对于实现全球结核病负担的大幅减少至关重要。然而，广泛开展筛查和治疗需要仔细考虑成本效益，同时确保解决持续疾病传播的驱动因素。
