Alfaqeeh Mohammed, Santoso Prayudi, Alffenaar Jan-Willem, Pradipta Ivan S
Doctoral Program of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
J Multidiscip Healthc. 2025 Jun 17;18:3531-3544. doi: 10.2147/JMDH.S517965. eCollection 2025.
Drug-resistant tuberculosis (DR-TB) continues to be a major global health threat, and while advancements in drug therapies have been made, the role of pharmacists in improving patient outcomes has not been fully optimized. This review aims to describe the types, resistance mechanisms, and management strategies of DR-TB, with a focus on discussing the critical role of pharmacists in optimizing treatment outcomes for DR-TB patients. A narrative review approach was adopted to provide an updated and evidence-based perspective. Additionally, manual review of reference lists from the retrieved articles was performed to identify additional relevant studies. The review identifies types of DR-TB, including mono-, poly-, rifampicin-, multi-, pre-extensively, and extensively-drug resistance. Resistance mechanisms are outlined, highlighting mutations in key genes, such as those involved in rifampicin and isoniazid (INH) resistance, which compromise treatment efficacy. The treatment regimens for DR-TB include the INH-R regimen, Bedaquiline, Pretomanid, and Linezolid (with or without Moxifloxacin) (BPaL(M) regimen, shorter oral regimen, and longer oral regimen, each tailored to the specific resistance pattern and patient condition. The challenges in managing DR-TB include complex treatment regimens and side effects, social barriers such as stigma and adherence issues, and system-related obstacles like limited resources and healthcare infrastructure. The review underscores pharmacists' vital yet underutilized role in addressing challenges. Pharmacists' contributions include patient counseling to improve adherence, and optimizing regimens for vulnerable populations and therapeutic drug monitoring. Addressing DR-TB requires a multifaceted approach, with pharmacists playing a critical role in its management. Their contributions are key to improving patient outcomes and overcoming the challenges associated with DR-TB management.
耐多药结核病（DR-TB）仍然是全球主要的健康威胁，尽管药物治疗已取得进展，但药剂师在改善患者治疗效果方面的作用尚未得到充分优化。本综述旨在描述耐多药结核病的类型、耐药机制和管理策略，重点讨论药剂师在优化耐多药结核病患者治疗效果方面的关键作用。采用叙述性综述方法提供最新的循证观点。此外，还对检索到的文章的参考文献列表进行了人工检索，以识别其他相关研究。该综述确定了耐多药结核病的类型，包括单耐药、多耐药、利福平耐药、广泛耐药、准广泛耐药和广泛耐药。概述了耐药机制，强调关键基因的突变，如那些与利福平和异烟肼（INH）耐药相关的基因，这些突变会损害治疗效果。耐多药结核病的治疗方案包括INH-R方案、贝达喹啉、普瑞玛尼和利奈唑胺（有或没有莫西沙星）（BPaL(M)方案、较短的口服方案和较长的口服方案，每种方案都根据特定的耐药模式和患者情况量身定制。耐多药结核病管理中的挑战包括复杂的治疗方案和副作用、耻辱感和依从性问题等社会障碍，以及资源有限和医疗基础设施不足等与系统相关的障碍。该综述强调了药剂师在应对这些挑战方面至关重要但未得到充分利用的作用。药剂师的贡献包括为患者提供咨询以提高依从性，为弱势群体优化治疗方案以及进行治疗药物监测。应对耐多药结核病需要采取多方面的方法，药剂师在其管理中发挥着关键作用。他们的贡献对于改善患者治疗效果和克服与耐多药结核病管理相关的挑战至关重要。
