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Diagnosis and treatment of multidrug-resistant tuberculosis

Yeungnam University Journal of Medicine 2020년 37권 4호 p.277 ~ 285
장종걸, 정진홍,
소속 상세정보
장종걸 ( Jang Jong-Geol ) - Yeungnam University College of Medicine Department of Internal Medicine
정진홍 ( Chung Jin-Hong ) - Yeungnam University College of Medicine Department of Internal Medicine

Abstract


Tuberculosis (TB) is still a major health problem worldwide. Especially, multidrug-resistant TB (MDR-TB), which is defined as TB that shows resistance to both isoniazid and rifampicin, is a barrier in the treatment of TB. Globally, approximately 3.4% of new TB patients and 20% of the patients with a history of previous treatment for TB were diagnosed with MDR-TB. The treatment of MDR-TB requires medications for a long duration (up to 20?24 months) with less effective and toxic second-line drugs and has unfavorable outcomes. However, treatment outcomes are expected to improve due to the introduction of a new agent (bedaquiline), repurposed drugs (linezolid, clofazimine, and cycloserine), and technological advancement in rapid drug sensitivity testing. The World Health Organization (WHO) released a rapid communication in 2018, followed by consolidated guidelines for the treatment of MDR-TB in 2019 based on clinical trials and an individual patient data meta-analysis. In these guidelines, the WHO suggested reclassification of second-line anti-TB drugs and recommended oral treatment regimens that included the new and repurposed agents. The aims of this article are to review the treatment strategies of MDR-TB based on the 2019 WHO guidelines regarding the management of MDR-TB and the diagnostic techniques for detecting resistance, including phenotypic and molecular drug sensitivity tests.

키워드

Diagnosis; Multidrug-resistant tuberculosis; Treatment

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