Emerg Infect Dis. 2024 Aug;30(8):1571-1579. doi: 10.3201/eid3008.240541.
New tuberculosis (TB) drugs with little existing antimicrobial resistance enable a pan-TB treatment regimen, intended for universal use without prior drug-susceptibility testing. However, widespread use of such a regimen could contribute to an increasing prevalence of antimicrobial resistance, potentially rendering the pan-TB regimen ineffective or driving clinically problematic patterns of resistance. We developed a model of multiple sequential TB patient cohorts to compare treatment outcomes between continued use of current standards of care (guided by rifampin-susceptibility testing) and a hypothetical pan-TB approach. A pan-TB regimen that met current target profiles was likely to initially outperform the standard of care; however, a rising prevalence of transmitted resistance to component drugs could make underperformance likely among subsequent cohorts. Although the pan-TB approach led to an increased prevalence of resistance to novel drugs, it was unlikely to cause accumulation of concurrent resistance to novel drugs and current first-line drugs.
新的结核病（TB）药物耐药性低，能够实现全结核病治疗方案，旨在无需事先进行药物敏感性测试的情况下普遍使用。然而，此类方案的广泛使用可能会导致抗菌药物耐药性的增加，从而使全结核病治疗方案无效或导致临床上出现耐药性问题。我们开发了一个多序列结核病患者队列模型，以比较继续使用当前护理标准（根据利福平药敏试验指导）和假设的全结核病方法的治疗结果。符合当前目标特征的全结核病方案可能最初优于标准护理；然而，随着对组成药物的耐药性传播的增加，后续队列的表现可能不佳。虽然全结核病方法导致对新药物的耐药性增加，但不太可能导致对新药物和当前一线药物的同时耐药性的积累。
