Michalik Maciej, Lorenc Tomasz, Marcinkowski Krzysztof, Muras Mateusz, Mikszta Natalia, Mikszta Jakub, Kantor Karolina, Marcinkowska Julia
Warsaw Southern Hospital, Warsaw, Poland.
Ludwik Rydygier Specialist Hospital, Cracow, Poland.
GMS Hyg Infect Control. 2025 Jun 26;20:Doc33. doi: 10.3205/dgkh000562. eCollection 2025.
Drug-resistant tuberculosis (DR-TB) poses a significant global health threat, particularly in low- and middle-income countries with limited access to quality healthcare. By 2023, 10% of global tuberculosis cases were classified as drug-resistant, with multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) showing increasing prevalence. The treatment of DR-TB has been complicated by long regimens, severe side effects and high overall costs, which contribute to non-adherence and treatment failures. Novel pharmacological agents including bedaquiline, linezolid, meropenem and more, have shown promise in improving treatment outcomes, shortening therapy duration, and enhancing patient compliance. These drugs have demonstrated effectiveness in both MDR-TB and XDR-TB cases, particularly when used in combination therapies as BPaLM (the combination of bedaquiline, pretomanid, linezolid and moxifloxacin). However, challenges remain, including limited access to drugs, diagnostic tools, and healthcare infrastructure, particularly in high-burden regions. Although regimens incorporating these agents offer improved treatment success rates, they require careful monitoring due to potential side effects and the risk of resistance. Future research should focus on refining these regimens, optimizing drug use for resource-limited settings, and addressing logistical and economic barriers to ensure more effective and accessible treatment. The ultimate goal is to reduce the global burden of DR-TB and improve outcomes for affected populations.
耐多药结核病对全球健康构成重大威胁，在获得优质医疗服务机会有限的低收入和中等收入国家尤为如此。到2023年，全球10%的结核病病例被归类为耐药病例，耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）的患病率呈上升趋势。耐多药结核病的治疗因疗程长、副作用严重和总体成本高而变得复杂，这些因素导致治疗依从性差和治疗失败。包括贝达喹啉、利奈唑胺、美罗培南等在内的新型药物在改善治疗效果、缩短治疗疗程和提高患者依从性方面显示出前景。这些药物在耐多药结核病和广泛耐药结核病病例中均已证明有效，特别是在作为BPaLM（贝达喹啉、普瑞玛尼、利奈唑胺和莫西沙星的联合使用）联合治疗时。然而，挑战依然存在，包括药物、诊断工具和医疗基础设施的可及性有限，特别是在高负担地区。尽管采用这些药物的治疗方案提高了治疗成功率，但由于潜在的副作用和耐药风险，需要仔细监测。未来的研究应侧重于优化这些治疗方案，针对资源有限的环境优化药物使用，并解决后勤和经济障碍，以确保提供更有效、更可及的治疗。最终目标是减轻全球耐多药结核病负担，改善受影响人群的治疗效果。
