关于多药耐药结核病预防治疗的最新情况,以实现全球结核病消除
Alberto Matteelli1, Sofia Lovatti1, Benedetta Rossi2
1Clinic of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
概括
六个月的勒沃素显著降低了接触者的多抗药结核病 (MDR-TB) 发病率. 世界卫生组织推的这种治疗方法提供了一种安全有效的预防策略,可以预防多抗药性结核病的传播.
科学领域:
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
- 微生物学 微生物学
背景情况:
- 耐多药结核病 (MDR-TB) 是一个严重的全球健康威胁,由世界卫生组织优先考虑.
- 对MDR-TB病例接触者的预防性治疗 (TPT) 是至关重要的,但历史上缺乏强有力的证据.
- 之前的指导方针建议对MDR-TB接触者进行TPT监测.
研究的目的:
- 评估勒沃素 (Lfx) 作为TPT的疗效,用于暴露于MDR-TB的家庭接触者.
- 为更新世卫组织关于预防MDR-TB的指导方针提供证据.
- 解决关于MDR-TB的TPT的证据缺口.
主要方法:
- 进行了两项大规模前性随机对照试验 (VQUIN和TB-CHAMP).
- 这些试验比较了勒沃素 (Lfx) 与安慰剂,用于预防成人和儿童的MDR-TB.
- 进行了对试验数据的综合元分析.
主要成果:
- 对VQUIN和TB-CHAMP的元分析显示,使用Lfx.champ的结核病发病率在统计上显著减少了60%.
- 列沃素TPT具有成本效益,安全,有效,并且与艾滋病毒疗法没有相互作用.
- 现在,世卫组织建议在接触者中每天服用6个月的Lfx,这些接触者暴露于MDR/胺耐药结核病.
结论:
- 列沃素是MDR-TB接触者推的TPT,可显著降低TB发病率.
- 新出现的担忧包括先前广泛耐药性 (XDR) - - 结核病,需要进行持续的研究.
- 未来的试验 (PHOENIx,BRANCH-TB) 旨在扩大对XDR-TB的TPT选择,并解决药物不耐受性,以实现结核病的消除.
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