Humma L M
University of Georgia, Athens, USA.
Am J Health Syst Pharm. 1996 Oct 1;53(19):2291-8; quiz 2335-6. doi: 10.1093/ajhp/53.19.2291.
Therapy recommended for preventing and treating drug-resistant tuberculosis is discussed. Drug-resistant strains of Mycobacterium tuberculosis can be transmitted by an infected individual, or resistance can be acquired during therapy for drug-susceptible disease. At least until susceptibility test data are available, the recommended initial treatment for tuberculosis consists of isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Resistance has led to variations on this regimen that sometimes include more toxic alternative drugs, including ethionamide, aminosalicylic acid, cycloserine, and capreomycin, as well as ciprofloxacin and ofloxacin. Drug regimens used for retreatment usually include the alternative drugs. Success in treating drug-resistant tuberculosis varies. Therapy to prevent resistant tuberculosis is recommended for any individual with a positive skin-test result and any of the following: infection with the human immunodeficiency virus (HIV), close contact with a newly diagnosed patient, recent conversion to a positive skin-test result, or a predisposing medical condition. Although isoniazid is the only drug with FDA-approved labeling for use as prophylaxis in patients with latent tuberculosis, the Centers for Disease Control and Prevention suggests several two-drug combinations. Fluoroquinolones are recommended for both treatment and prevention. Patient compliance and HIV infection are special issues in managing resistant tuberculosis. Drug-resistant tuberculosis is a growing problem that must be addressed through appropriate prophylactic and treatment measures.
本文讨论了预防和治疗耐药结核病的推荐疗法。结核分枝杆菌的耐药菌株可由感染者传播，也可在药敏结核病治疗期间获得耐药性。至少在药敏试验数据可得之前，推荐的结核病初始治疗方案包括异烟肼、利福平、吡嗪酰胺以及乙胺丁醇或链霉素。耐药性导致了该方案的变化，有时会包括毒性更强的替代药物，如乙硫异烟胺、对氨基水杨酸、环丝氨酸和卷曲霉素，以及环丙沙星和氧氟沙星。复治使用的药物方案通常包括这些替代药物。治疗耐药结核病的成功率各不相同。对于任何皮肤试验结果呈阳性且有以下情况之一的个体，建议进行预防耐药结核病的治疗：感染人类免疫缺陷病毒（HIV）、与新诊断患者密切接触、近期皮肤试验结果转为阳性或有易患疾病。虽然异烟肼是唯一一种经美国食品药品监督管理局（FDA）批准用于潜伏性结核病患者预防治疗的药物，但疾病控制与预防中心建议了几种双药联合方案。氟喹诺酮类药物推荐用于治疗和预防。患者依从性和HIV感染是管理耐药结核病中的特殊问题。耐药结核病是一个日益严重的问题，必须通过适当的预防和治疗措施加以解决。
