儿童多药耐药结核病:流行病学,诊断,治疗和预防的实用更新
James T Gaensbauer1,2, Nabaneeta Dash3, Sanjay Verma4
1Mayo Clinic Center for Tuberculosis, Mayo Clinic, Rochester, MN, USA.
概括
儿童多耐药结核病 (MDR-TB) 诊断和治疗面临挑战,但新的快速测试和更短的全口服药物治疗方案为儿童提供了更好的结果的希望. 需要进一步的儿科试验以获得最佳的管理.
科学领域:
- 儿童传染病 儿童传染病
- 菌株学 菌株学 菌株学
- 全球卫生健康 全球卫生健康
背景情况:
- 儿科多药耐药结核病 (MDR-TB) 是一个关键的全球卫生问题,存在重大诊断和治疗障碍.
- 据估计,每年有不到5%的儿科MDR-TB病例是微生物确诊的,导致结果差,死亡率增加.
- 传统的MDR-TB治疗方案是漫长的,涉及多种药物,通常包括有毒的注射剂.
研究的目的:
- 审查儿童MDR-TB的诊断和治疗方面的最新进展.
- 突出在儿童中识别,确认和管理MDR-TB的挑战.
- 讨论新药和治疗方案的潜力,以改善患有MDR-TB的儿童的治疗结果.
主要方法:
- 关于儿科MDR-TB诊断和治疗的当前文献的综述.
- 案例说明管理挑战和潜在的成功.
- 讨论新兴的快速分子测试和新药疗法.
主要成果:
- 快速分子测试的利法敏感性正在变得可用,但面临的样本采集和 paucibacillary性质的挑战在儿童中.
- 新的药物,如贝达基林,德拉曼尼德,克洛法齐明和莱因佐利德,可实现更短,全口服的MDR-TB治疗方案.
- 目前对于幼儿短时间全口服治疗方案 (包括普雷托曼尼德) 的数据不够.
结论:
- 诊断和治疗方面的进步为改善儿科MDR-TB管理提供了希望.
- 儿童临床试验对于评估新药和MDR-TB治疗方案至关重要.
- 优化诊断和治疗对于降低死亡率和改善MDR-TB儿童的治疗结果至关重要.
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