Seo Wan, Kim Hyung Woo, Lee Eung Gu, An Tai Joon, Kim Seunghoon, Jeong Yun-Jeong, Lee Sang Haak, Park Yeonhee, Mok Jeongha, Oh Jee Youn, Ko Yousang, Kim Sun-Hyung, Kwon Sun Jung, Jung Sung Soo, Kim Jin Woo, Kim Ju Sang, Min Jinsoo
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Infect Drug Resist. 2023 Aug 11;16:5233-5242. doi: 10.2147/IDR.S420830. eCollection 2023.
Isoniazid-monoresistant tuberculosis (Hr-TB) has emerged as a global challenge, necessitating detailed guidelines for its diagnosis and treatment. We aim to consolidate the Korean guidelines for Hr-TB management by gathering expert opinions and reaching a consensus.
A conventional Delphi method involving two rounds of surveys was conducted with 96 experts selected based on their clinical and research experience and involvement in nationwide tuberculosis studies and development of the Korean guidelines on tuberculosis. The survey consisted of three sections of questionnaires on diagnosis, treatment, and general opinions on Hr-TB.
Among the 96 experts, 72 (75%) participated in the two rounds of the survey. A majority of experts (96%) strongly agreed on the necessity of molecular drug susceptibility testing (DST) for isoniazid and rifampin resistance in all tuberculosis patients and emphasized the importance of interpreting mutation types (inhA or katG) and additional molecular DST for fluoroquinolones for confirmed isoniazid-resistant cases. Over 95.8% of experts recommended treating Hr-TB with a combination of rifampin, ethambutol, pyrazinamide, and levofloxacin for six months, without exceeding 12 months unless necessary. They also acknowledged the drawbacks of long-term pyrazinamide use due to its side effects and agreed on shortening its duration by extending the duration of the rest of the treatment with a modified combination of choice.
This Delphi survey enabled Korean tuberculosis experts to reach a consensus on diagnosing and treating Hr-TB. These findings will be valuable for developing the upcoming revised Korean guidelines for Hr-TB management.
异烟肼单耐药结核病（Hr-TB）已成为一项全球性挑战，因此需要针对其诊断和治疗制定详细指南。我们旨在通过收集专家意见并达成共识，整合韩国关于Hr-TB管理的指南。
采用传统的德尔菲法，进行两轮调查，参与的96位专家是根据其临床和研究经验以及参与全国结核病研究和韩国结核病指南制定情况挑选出来的。调查包括关于诊断、治疗以及对Hr-TB的总体意见三部分问卷。
96位专家中，72位（75%）参与了两轮调查。大多数专家（96%）强烈认同对所有结核病患者进行异烟肼和利福平耐药的分子药敏试验（DST）的必要性，并强调解读突变类型（inhA或katG）以及对确诊的异烟肼耐药病例进行氟喹诺酮类药物额外分子DST的重要性。超过95.8%的专家建议采用利福平、乙胺丁醇、吡嗪酰胺和左氧氟沙星联合治疗Hr-TB六个月，除非必要，疗程不超过12个月。他们也认识到长期使用吡嗪酰胺因其副作用存在弊端，并同意通过延长其余治疗的改良联合用药疗程来缩短其使用时间。
这项德尔菲调查使韩国结核病专家就Hr-TB的诊断和治疗达成了共识。这些结果对于制定即将修订的韩国Hr-TB管理指南具有重要价值。
