Sanchez-Montalva Adrian, Caminero José Antonio, Guna Mª Remedio, Sanz Teresa Rodrígo, Rabuñal Ramón, Millet Joan Pau, Gullón-Blanco José Antonio, Anibarro Luis, Perez-Mendoza Guillermo, Medina Juan Francisco, González-Galán Verónica, Tabernero Eva
International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Autonomous University of Barcelona, Spain; Mycobacterial Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain; For Biomedical Research Centre in Infectious Diseases Network (CIBERINFEC), Carlos III Health Institute, Madrid, Spain.
Prof. Head of the Pulmonology Service at the Dr. Negrín General University Hospital, Las Palmas de GC, Spain; Director of Scientific Activities ALOSA TB ACADEMY, Spain.
Arch Bronconeumol. 2024 Dec;60(12):759-767. doi: 10.1016/j.arbres.2024.08.001. Epub 2024 Dec 2.
The Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) have developed together Clinical Practice Guidelines (GPC) on the management of people affected by tuberculosis (TB) resistant to drugs with activity against Mycobacterium tuberculosis. These clinical practice guidelines include the latest updates of the SEPAR regulations for the diagnosis and treatment of drug-resistant TB from 2017 and 2020 as the starting point. The methodology included asking relevant clinical questions based on PICO methodology, a literature search focusing on each question, and a systematic and comprehensive evaluation of the evidence, with a summary of this evidence for each question. Finally, recommendations were developed and the level of evidence and the strength of each recommendation for each question were established in concordance with the GRADE approach. Of the recommendations made, it is worth highlighting the high quality of the existing evidence for the use of nucleic acid amplification techniques (rapid genotypic tests) as initial tests for the detection of the M. tuberculosis genome and rifampicin resistance in people with presumptive signs or symptoms of pulmonary TB; and for the use of an oral combination of anti-TB drugs based on bedaquiline, delamanid (pretomanid), and linezolid, with conditional fluoroquinolone supplementation (conditioned by fluoroquinolone resistance) for six months for the treatment of people affected by pulmonary multidrug-resistant tuberculosis (MDR-TB). We also recommend directly observed therapy (DOT) or video-observed treatment for the treatment of people affected by DR-TB.
西班牙肺病与胸外科协会（SEPAR）和西班牙传染病与临床微生物学协会（SEIMC）共同制定了关于耐抗结核分枝杆菌药物的结核病（TB）患者管理的临床实践指南（GPC）。这些临床实践指南以2017年和2020年SEPAR耐药结核病诊断和治疗法规的最新更新为起点。该方法包括基于PICO方法提出相关临床问题、针对每个问题进行文献检索、对证据进行系统全面的评估，并对每个问题的证据进行总结。最后，制定了建议，并根据GRADE方法确定了每个问题的证据水平和每项建议的强度。在提出的建议中，值得强调的是，现有证据质量很高，支持将核酸扩增技术（快速基因分型检测）用作对有肺结核疑似体征或症状者进行结核分枝杆菌基因组和利福平耐药性检测的初始检测方法；以及支持使用基于贝达喹啉、德拉马尼（普瑞马尼）和利奈唑胺的口服抗结核药物联合方案，并根据氟喹诺酮耐药情况有条件地补充氟喹诺酮，用于治疗耐多药肺结核（MDR-TB）患者六个月。我们还建议对耐多药结核病患者采用直接观察治疗（DOT）或视频观察治疗。
