WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update

被引：431

作者：

Falzon, D. ^{[1
]}

Jaramillo, E. ^{[1
]}

Schuenemann, H. J. ^{[2
]}

Arentz, M. ^{[3
]}

Bauer, M. ^{[4
]}

Bayona, J. ^{[5
]}

Blanc, L. ^{[1
]}

Caminero, J. A. ^{[6
,7
]}

Daley, C. L. ^{[8
]}

Duncombe, C. ^{[9
]}

Fitzpatrick, C. ^{[1
]}

Gebhard, A. ^{[10
]}

Getahun, H. ^{[1
]}

Henkens, M. ^{[11
]}

Holtz, T. H. ^{[12
]}

Keravec, J. ^{[13
]}

Keshavjee, S. ^{[14
]}

Khan, A. J. ^{[15
]}

Kulier, R.

Leimane, V. ^{[16
]}

Lienhardt, C. ^{[17
]}

Lu, C. ^{[18
]}

Mariandyshev, A. ^{[19
]}

Migliori, G. B. ^{[20
]}

Mirzayev, F. ^{[1
]}

Mitnick, C. D. ^{[18
]}

Nunn, P. ^{[1
]}

Nwagboniwe, G. ^{[21
]}

Oxlade, O. ^{[4
]}

Palmero, D. ^{[22
]}

Pavlinac, P. ^{[3
]}

Quelapio, M. I. ^{[23
]}

Raviglione, M. C. ^{[1
]}

Rich, M. L. ^{[14
]}

Royce, S. ^{[24
]}

Ruesch-Gerdes, S. ^{[25
]}

Salakaia, A. ^{[13
]}

Sarin, R. ^{[26
]}

Sculier, D. ^{[1
]}

Varaine, F. ^{[11
]}

Vitoria, M. ^{[9
]}

Walson, J. L. ^{[3
]}

Wares, F. ^{[1
]}

Weyer, K. ^{[1
]}

White, R. A. ^{[27
]}

Zignol, M. ^{[1
]}

机构：

[1] WHO, Stop TB Dept, CH-1211 Geneva 27, Switzerland

[2] McMaster Univ Hlth Sci, Hamilton, ON, Canada

[3] Univ Washington, Seattle, WA 98195 USA

[4] McGill Univ, Montreal, PQ, Canada

[5] Socios Salud Sucursal, Lima, Peru

[6] Univ Gen Hosp Gran Canaria, Dept Pneumol, Las Palmas Gran Canaria, Spain

[7] The UNION, Paris, France

[8] Natl Jewish Hlth, Denver, CO USA

[9] WHO, HIV Dept, CH-1211 Geneva 27, Switzerland

[10] KNCV TB Fdn, The Hague, Netherlands

[11] Med Sans Frontieres, Paris, France

[12] CDC, Bangkok, Thailand

[13] Management Sci Hlth, Arlington, VA USA

[14] Partners In Hlth, Boston, MA USA

[15] Indus Hosp, Karachi, Pakistan

[16] Clin TB & Lung Dis, State Infectol Ctr, Riga, Latvia

[17] WHO, Stop TB Partnership, CH-1211 Geneva 27, Switzerland

[18] Harvard Univ, Sch Med, Boston, MA USA

[19] No State Med Univ, Arkhangelsk, Russia

[20] Fdn S Maugeri, WHO Collaborating Ctr TB & Lung Dis, Tradate, Italy

[21] Alliance Hope, Asaba, Nigeria

[22] Hosp Muniz, Buenos Aires, DF, Argentina

[23] Trop Dis Fdn, Manila, Philippines

[24] PATH, Seattle, WA USA

[25] Natl Reference Ctr Mycobacteria, Borstel, Germany

[26] LRS Inst TB & Allied Dis, New Delhi, India

[27] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA

来源：

EUROPEAN RESPIRATORY JOURNAL | 2011年 / 38卷 / 03期

关键词：

Ambulatory care facilities; diagnosis; drug therapy; guideline; multidrug-resistant tuberculosis; MULTIDRUG-RESISTANT; COST-EFFECTIVENESS; TREATMENT OUTCOMES; SOUTH-AFRICA; DIAGNOSIS; FEASIBILITY; COHORT;

D O I：

10.1183/09031936.00073611

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

The production of guidelines for the management of drug-resistant tuberculosis (TB) fits the mandate of the World Health Organization (WHO) to support countries in the reinforcement of patient care. WHO commissioned external reviews to summarise evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant TB (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. A multidisciplinary expert panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. The recommendations support the wider use of rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone using molecular techniques. Monitoring by sputum culture is important for early detection of failure during treatment. Regimens lasting >= 20 months and containing pyrazinamide, a fluoroquinolone, a second-line injectable drug, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid are recommended. The guidelines promote the early use of antiretroviral agents for TB patients with HIV on second-line drug regimens. Systems that primarily employ ambulatory models of care are recommended over others based mainly on hospitalisation. Scientific and medical associations should promote the recommendations among practitioners and public health decision makers involved in MDR-TB care. Controlled trials are needed to improve the quality of existing evidence, particularly on the optimal composition and duration of MDR-TB treatment regimens.

引用

页码：516 / 528

页数：13

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