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Management of patients with multidrug-resistant tuberculosis

2019; International Union Against Tuberculosis and Lung Disease; Volume: 23; Issue: 6 Linguagem: Inglês

10.5588/ijtld.18.0622

1815-8439

Christoph Lange, Rob E. Aarnoutse, J. W. C. Alffenaar, Graham Bothamley, Folke Brinkmann, Júlio Pereira Costa, Dumitru Chesov, Reinout van Crevel, Martin Dedicoat, José Domínguez, Raquel Duarte, Hans-Peter Grobbel, Gunar Günther, Lorenzo Guglielmetti, Jan Heyckendorf, Alexander Kay, Ohanna Kirakosyan, Ole Kirk, Rembert A. Koczulla, Grigorii Kudriashov, Līga Kukša, Frank van Leth, Cécile Magis-Escurra, Anna M. Mandalakas, Bárbara Molina-Moya, Charles A. Peloquin, Maja Reimann, Rudolf Rumetshofer, H. Simon Schaaf, Thomas Schön, Simon Tiberi, J. Valda, Piotr Yablonskii, Keertan Dheda,

Cancer therapeutics and mechanisms

The emergence of multidrug-resistant tuberculosis (MDR-TB; defined as resistance to at least rifampicin and isoniazid) represents a growing threat to public health and economic growth.Never before in the history of mankind have more patients been affected by MDR-TB than is the case today.The World Health Organization reports that MDR-TB outcomes are poor despite staggeringly high management costs.Moreover, treatment is prolonged, adverse events are common, and the majority of affected patients do not receive adequate treatment.As MDR-TB strains are often resistant to one or more second-line anti-TB drugs, in-depth genotypic and phenotypic drug susceptibility testing is needed to construct personalised treatment regimens to improve treatment outcomes.For the first time in decades, the availability of novel drugs such as bedaquiline allow us to design potent and well-tolerated personalised MDR-TB treatment regimens based solely on oral drugs.In this article, we present management guidance to optimise the diagnosis, algorithm-based treatment, drug dosing and therapeutic drug monitoring, and the management of adverse events and comorbidities, associated with MDR-TB.We also discuss the role of surgery, physiotherapy, rehabilitation, palliative care and smoking cessation in patients with MDR-TB.We hope that incorporating these recommendations into patient care will be helpful in optimising treatment outcomes, and lead to more MDR-TB patients achieving a relapse-free cure.K E Y W O R D S : MDR-TB; RESIST-TB; TBNET; TB; XDR-TB; personalised treatment TUBERCULOSIS (TB) IS an airborne infectious disease caused by Mycobacterium tuberculosis.The World Health Organization (WHO) estimates that approximately 10.0 million people developed TB, and 1.6 million people died from the disease in 2017. 1 TB is the leading cause of death attributed to a single micro-organism worldwide.The emergence of drug-resistant strains of M.tuberculosis has complicated TB control and subverted the goals of the WHO's End TB Strategy (95% reduction in deaths due to TB and a 90% reduction in TB incidence rate by the year 2035 compared to 2015). 2 According to WHO TB reports, the number of patients with a confirmed diagnosis of multidrugresistant TB (MDR-TB; defined as resistance of M. tuberculosis to at least rifampicin [RMP] and isoniazid [INH]) has increased in the past years from ~84 000 in 2012 to ~153 000 in 2017. 1 This development is only partly explained by better diagnostic capacities.The estimated total burden of patients with MDR-TB is much higher and has increased from 450 000 in 2012 to 458 000 in 2017. 1 Extensively drug-resistant TB (XDR-TB), defined as MDR-TB plus resistance to a fluoroquinolone (FQ) and at least one second-line injectable