Liverpool School of Tropical Medicine, Liverpool, UK, Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi, University of Sheffield, Sheffield, UK.
Liverpool School of Tropical Medicine, Liverpool, UK, Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
Int J Tuberc Lung Dis. 2018 Oct 1;22(10):1127-1134. doi: 10.5588/ijtld.17.0705.
To assess the clinical outcomes of patients prescribed the World Health Organization (WHO) Category II retreatment regimen for tuberculosis (TB).
A systematic review of the literature was performed by searching Medscape, Embase and Scopus databases for cohort studies and clinical trials reporting outcomes in adult patients on the Category II retreatment regimen.
The proportion of patients successfully completing the retreatment regimen varied from 27% to 92% in the 39 studies included in this review. In only 2/39 (5%) studies was the treatment success rate > 85%. There are very few data concerning outcomes in patients categorised as 'other', and outcomes in this subgroup are variable. Of the five studies reporting disaggregated outcomes in human immunodeficiency virus (HIV) positive people, four demonstrated worse outcomes than in HIV-negative people on the retreatment regimen. Only four studies reported disaggregated outcomes in patients with isoniazid (INH) resistance, and treatment success rates varied from 11% to 78%.
Clinical outcomes on the Category II retreatment regimen are poor across various populations. Improvements in management should consider the holistic treatment of comorbidity and comprehensive approaches to drug resistance in patients with recurrent TB, including a standardised approach for the management of INH resistance in patients who develop recurrent TB in settings without reliable access to comprehensive drug susceptibility testing.
评估世界卫生组织（WHO）结核病（TB）二类复治方案规定的患者的临床结局。
通过在 Medscape、Embase 和 Scopus 数据库中搜索报告成人患者接受二类复治方案结局的队列研究和临床试验，对文献进行系统回顾。
在本综述纳入的 39 项研究中，成功完成复治方案的患者比例从 27%到 92%不等。仅有 2/39（5%）的研究治疗成功率>85%。对于归类为“其他”的患者的结局数据非常少，且该亚组的结局各不相同。在报告了人类免疫缺陷病毒（HIV）阳性患者分类结局的五项研究中，有四项研究显示在复治方案中，HIV 阳性患者的结局比 HIV 阴性患者差。仅有四项研究报告了耐异烟肼（INH）患者的分类结局，治疗成功率从 11%到 78%不等。
在不同人群中，二类复治方案的临床结局均较差。管理改进应考虑合并症的整体治疗和复发性结核病患者耐药的综合方法，包括在没有可靠获得全面药物敏感性检测的情况下，对发展为复发性结核病的 INH 耐药患者管理制定标准化方法。
