de Kantor I N, Latini O, Barrera L
Organización Panamericana de la Salud (OPS/OMS), Buenos Aires, Argentina.
Medicina (B Aires). 1998;58(2):202-8.
Resistance of Mycobacterium tuberculosis to both isoniazid (INH) and rifampicin (RPM), the most important antituberculosis drugs, with or without simultaneous resistance to other drugs, is known as multidrug resistance (MDR). It is the main obstacle to attain the cure of patients by the specific treatment, and a threat to the tuberculosis control. Between 1994 and 1997, several Latin American countries undertook countrywide surveys or surveillance programs to determine their primary and acquired drug resistance prevalence rates. These studies followed the WHO/International Union Against Tuberculosis and Lung Diseases (IUATLD) guidelines. Percentages of not previously treated patients with tuberculosis due to MDR strains ranged from null or very small (Uruguay, Cuba, Chile) to 4% or higher (Dominican Republic, Argentina). In Argentina, a remarkable correlation between MDR tuberculosis, AIDS and the assistance in urban reference hospitals for infections diseases was observed. Coincidentally with the survey, nosocomial spread of HIV-related MDR tuberculosis occurred in two of these hospitals situated in Buenos Aires and Rosario. But, at the same time, an alarming emergence of MDR was evidenced among non HIV-infected patients with history of previous antituberculosis treatment. Directly observed treatment (DOT) should be increasingly applied, and drug supply guaranteed. Treatment as well as microscopy services for diagnosis and follow up of patients, should be decentralized from the big specialized hospitals in urban areas to the peripheral health centers, in order to make easier for the patients to attend regularly and receive their medications. These strategies will contribute to increase cure rates and to reduce the tuberculosis transmission.
结核分枝杆菌对两种最重要的抗结核药物异烟肼（INH）和利福平（RPM）产生耐药性，无论是否同时对其他药物耐药，都被称为多重耐药（MDR）。这是通过特异性治疗治愈患者的主要障碍，也是结核病控制的一大威胁。1994年至1997年间，几个拉丁美洲国家开展了全国性调查或监测项目，以确定其原发性和获得性耐药患病率。这些研究遵循了世界卫生组织/国际抗结核和肺病联盟（IUATLD）的指南。因耐多药菌株导致的既往未接受过治疗的结核病患者比例从无或极低（乌拉圭、古巴、智利）到4%或更高（多米尼加共和国、阿根廷）不等。在阿根廷，耐多药结核病、艾滋病与城市传染病参考医院的医疗救助之间存在显著相关性。与调查同时，在布宜诺斯艾利斯和罗萨里奥的两家此类医院发生了与艾滋病毒相关的耐多药结核病的医院内传播。但与此同时，在有既往抗结核治疗史的非艾滋病毒感染患者中，耐多药情况也惊人地出现了。应越来越多地采用直接观察治疗（DOT），并确保药物供应。治疗以及用于患者诊断和随访的显微镜检查服务，应从城市地区的大型专科医院下放到周边卫生中心，以便患者更易于定期就诊并接受药物治疗。这些策略将有助于提高治愈率并减少结核病传播。
