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Lancet. 2019 Sep 14;394(10202):953-966. doi: 10.1016/S0140-6736(19)31882-3.

Management of drug-resistant tuberculosis.

Author information

1
Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; German Center for Infection Research Clinical Tuberculosis Unit, Borstel, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden. Electronic address: clange@fz-borstel.de.
2
Department of Medicine, Division of Pulmonology, Centre for Lung Infection and Immunity, Lung Institute, and Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
3
Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Department of Pneumology and Alergollogy, Nicoale Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova.
4
The Global Tuberculosis Programme, Texas Children's Hospital, and Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
5
Hinduja Hospital and Research Center, Veer Savarkar Marg, Mumbai, India.
6
Department of Medicine, School of Medicine, and Department of Epidemiology, Department of Biostatistics, and Department of Global Health, School of Public Health, Boston University, Boston, MA, USA.

Abstract

Drug-resistant tuberculosis is a major public health concern in many countries. Over the past decade, the number of patients infected with Mycobacterium tuberculosis resistant to the most effective drugs against tuberculosis (ie, rifampicin and isoniazid), which is called multidrug-resistant tuberculosis, has continued to increase. Globally, 4·6% of patients with tuberculosis have multidrug-resistant tuberculosis, but in some areas, like Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, this proportion exceeds 25%. Treatment for patients with multidrug-resistant tuberculosis is prolonged (ie, 9-24 months) and patients with multidrug-resistant tuberculosis have less favourable outcomes than those treated for drug-susceptible tuberculosis. Individualised multidrug-resistant tuberculosis treatment with novel (eg, bedaquiline) and repurposed (eg, linezolid, clofazimine, or meropenem) drugs and guided by genotypic and phenotypic drug susceptibility testing can improve treatment outcomes. Some clinical trials are evaluating 6-month regimens to simplify management and improve outcomes of patients with multidrug-resistant tuberculosis. Here we review optimal diagnostic and treatment strategies for patients with drug-resistant tuberculosis and their contacts.

PMID:
31526739
DOI:
10.1016/S0140-6736(19)31882-3
[Indexed for MEDLINE]

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