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J Bras Pneumol. 2018 Apr;44(2):153-160. doi: 10.1590/s1806-37562017000000436.

New and repurposed drugs to treat multidrug- and extensively drug-resistant tuberculosis.

[Article in English, Portuguese]

Author information

1
Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
2
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
3
Division of Infection, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom.
4
Hospital Nestor Goulart Reis, Secretaria de Estado da Saúde do Estado de São Paulo, Américo Brasiliense, SP, Brasil.
5
Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México.
6
Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal.
7
Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italia.
8
Division of Pulmonology, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italia.
9
Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias, Hospital Universitario, Universidad de Monterrey, Monterrey, Mexico.
10
7th Respiratory Medicine Department, Athens Chest Hospital, Athens, Greece.
11
Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom.

Abstract

Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB, respectively) continue to represent a challenge for clinicians and public health authorities. Unfortunately, although there have been encouraging reports of higher success rates, the overall rate of favorable outcomes of M/XDR-TB treatment is only 54%, or much lower when the spectrum of drug resistance is beyond that of XDR-TB. Treating M/XDR-TB continues to be a difficult task, because of the high incidence of adverse events, the long duration of treatment, the high cost of the regimens used, and the drain on health care resources. Various trials and studies have recently been undertaken (some already published and others ongoing), all aimed at improving outcomes of M/XDR-TB treatment by changing the overall approach, shortening treatment duration, and developing a universal regimen. The objective of this review was to summarize what has been achieved to date, as far as new and repurposed drugs are concerned, with a special focus on delamanid, bedaquiline, pretomanid, clofazimine, carbapenems, and linezolid. After more than 40 years of neglect, greater attention has recently been paid to the need for new drugs to fight the "white plague", and promising results are being reported.

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