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New Challenges in the Clinical Management of Drug-Resistant Tuberculosis

2002; Lippincott Williams & Wilkins; Volume: 11; Issue: 6 Linguagem: Inglês

10.1097/01.idc.0000078749.71576.0d

1536-9943

Joia S. Mukherjee, Sonya Shin, Jennifer Furin, Michael Rich, Fernet L andre, Jacob Joseph, Kwonjune J. Seung, J Acha, Irina Gelmanova, E. M. Goncharova, Alexander Pasechnikov, Felix Alc ntara Viru, Paul Farmer,

Infectious Diseases and Tuberculosis

Strains of Mycobacterium tuberculosis are multidrug-resistant when isoniazid and rifampin, the two most powerful antituberculous agents, do not inhibit their growth. Only a decade ago, outbreaks of multidrug-resistant tuberculosis (MDR-TB) occurred in New York, California, and Florida. In each setting, early detection by physicians decreased both transmission of and deaths caused by these strains. Working in Haiti, Peru, and Russia, our team has treated over 1,000 patients sick with MDR-TB. Most infecting strains were resistant to all first-line drugs. Because no new antituberculous drugs have been developed in decades, therapeutic options for such patients are limited. Our own experience suggests, however, that prompt detection and effective therapy can cure the great majority of cases of active MDR-TB. We review below the principles of MDR-TB treatment: 18–24 months of therapy with multidrug regimens, designed with use of drug susceptibility testing, and close attention to the management of adverse effects. We also discuss the treatment of MDR-TB in children, during pregnancy, and in the presence of HIV coinfection. Controversies in the management of MDR-TB are reviewed, including the use of resective surgery, the relative efficacy of different fluoroquinolones, and postexposure prophylaxis for close contacts of patients with pulmonary MDR-TB.