Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34020, Turkey.
Department of Pulmonary Disease, Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences Turkey, Istanbul 34149, Turkey.
Medicina (Kaunas). 2023 Jan 27;59(2):246. doi: 10.3390/medicina59020246.
: There is a lack of information regarding the effective duration of treatment necessary to prevent the development of acquired resistance when fluoroquinolones (FQ), and/or pyrazinamide (Z) resistance has occurred in patients with polydrug-resistant tuberculosis and isoniazid resistance. The management of these kinds of patients should be carried out in experienced centers according to drug susceptibility test results, clinical status of the patient and the extensity of the disease. : We evaluated treatment regimens, treatment outcomes, and drug adverse effects in seven patients with polydrug-resistant tuberculosis, including those with Z and/or FQ resistance in a retrospective analysis : Regarding the patients with polydrug-resistant tuberculosis in addition to isoniazid (H) resistance, three had Z, two had FQ, and the remaining two had both Z and FQ resistance. In the intensive phase of the treatment, the patients were given at least four drugs according to drug susceptibility tests, and at least three drugs in the continuation phase. The duration of treatment was 9-12 months. Two of the patients were foreign nationals, and could not be followed up with due to returning to their home countries. Regarding the remaining five patients, three of them were terminated as they completed treatment, and two as cured. No recurrence was observed in the first year of the treatment. The most common, and serious drug side effect was seen for amikacin. : In patients with polydrug-resistant TB, if Z and/or FQ resistance is detected in addition to H resistance, the treatment of these patients should be conducted on a case-by-case basis, taking into account the patient's resistance pattern, clinical condition, and disease prognosis. Close monitoring of the side effects will increase the success rate of the treatment.
在耐多药结核病和异烟肼耐药患者中出现氟喹诺酮（FQ）和/或吡嗪酰胺（Z）耐药时，预防获得性耐药发展所需的治疗持续时间的信息有限。根据药敏试验结果、患者的临床状况和疾病的严重程度，应在有经验的中心对这些患者进行管理。
我们在一项回顾性分析中评估了 7 例耐多药结核病患者（包括 Z 和/或 FQ 耐药患者）的治疗方案、治疗结果和药物不良反应。
对于耐多药结核病患者（除异烟肼（H）耐药外），3 例有 Z 耐药，2 例有 FQ 耐药，其余 2 例有 Z 和 FQ 耐药。在治疗的强化期，根据药敏试验结果，患者至少接受 4 种药物治疗，在延续期至少接受 3 种药物治疗。治疗持续时间为 9-12 个月。其中 2 例为外国籍患者，因返回原籍国而无法随访。对于其余 5 例患者，3 例因完成治疗而终止，2 例因治愈而终止。在治疗的第一年没有观察到复发。最常见和严重的药物副作用是阿米卡星。
在耐多药结核病患者中，如果除 H 耐药外还检测到 Z 和/或 FQ 耐药，则应根据患者的耐药模式、临床状况和疾病预后，对这些患者进行个体化治疗。密切监测药物不良反应将提高治疗成功率。
