针对耐药结核病的标准短期化疗:6个国家的治疗结果
M A Espinal1, S J Kim, P G Suarez
1World Health Organization, Communicable Diseases Programme, Ave Appia #20, 1211 Geneva 27, Switzerland. espinalm@who.ch
JAMA
|May 18, 2000
概括
标准的短期化疗对于某些多药耐药结核病 (TB) 病例是不够的. 与易感结核病患者相比,耐药结核病患者的治疗失败和死亡率明显高.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 临床医学 临床医学
背景情况:
- 耐多药结核病 (TB) 构成了全球重大卫生挑战.
- 在常规的结核病控制计划中,对多药耐药结核病对标准化疗结果的影响存在有限的大规模数据.
研究的目的:
- 评估在全球耐药性监测项目中招募的结核病患者标准一线短期化疗的有效性.
- 评估与药物耐药性模式相关的治疗结果.
主要方法:
- 在六个国家进行了回顾性队列研究:多米尼加共和国,香港,意大利,俄罗斯联邦,韩国共和国和秘鲁.
- 数据包括1994年至1996年期间使用标准第一线药物治疗的新增和重复治疗的结核病例.
- 对治疗的反应根据世卫组织的结果标准进行了分类.
主要成果:
- 在6402例培养阳性结核病例中,20.8%的新病例和44.5%的再治疗病例表现出耐药性,其中包括大量的抗药性结核病.
- 与敏感病例相比,多药耐药结核病病例的治疗失败率 (RR 15.4) 和死亡率 (RR 3.73) 显著更高.
- 即使有100%的直接观察,多药耐药结核病例的失败率也明显高 (10%vs0.7%).
结论:
- 使用一线药物的标准短期化疗对某些耐药结核病患者来说是不够的.
- 虽然直接观察的短期治疗策略至关重要,但需要进行修改,以加快对耐药结核病的鉴定,并将二线药物纳入治疗方案.
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