多重抗藥性結核病( MDR-TB)的防治讲解说明.pptVIP

Empiric? Include the standard recommendations plus at least four drugs effective against the most prevalent drug-resistant strains This may require that six or more drugs be given until drug susceptibility results are obtained Documented MDR? discontinue the drugs to which the isolate is resistant and to add at least two new drugs to which the isolate is susceptible most experts recommend that a parenteral aminoglycoside (streptomycin, kanamycin, amikacin, or capreomycin) and a quinolone (levofloxacin and moxifloxacin) be added. Treatment with parenteral agents is usually given for six months, and cures rates are high with medical therapy alone (in the 85 percent range) for MDR-TB regimens that include these two classes of drugs Treatment with at least four effective drugs should be continued for 18 to 24 months appropriate laboratory facilities to document drug susceptibility and monitor response should be available. These regimens should be administered by direct observation Adjunctive therapies ?Uncontrolled trials and anecdotal reports suggest that adjunctive immunotherapy with interferon-gamma (IFNg) may be useful in the management of multidrug-resistant tuberculosis Small observational studies suggested benefit in MDR-TB. However, a randomized trial of IFNg failed to confirm efficacy Criteria for Surgery in MDR-TB Localized lesions Reasonable lung function Two or more susceptible drugs available 多重抗藥性結核病（ MDR-TB)的防治 周振興 「多重抗藥性結核病」（ MDR-TB ）是指結核病人的痰檢體經培養及藥物敏感性試驗後發現至少同時對 Isoniazid （ INH ）及 Rifampin （ RMP ）二種第一線藥物具有抗藥性的病人 (廣泛抗藥性結核菌Extensively drug resistant tuberculosis,XDR-TB ) 若更嚴重進一步對任何 fluoroquinolone 藥物有抗藥性，且對於 3 種注射型的抗結核病二線藥物（ capreomycin, kanamycin, amikacin ）中至少 1 種出現抗藥性者，就會成為所謂超級抗藥性結核 (Extensively drug resistant tuberculosis,XDR-TB ；亦有翻譯為廣泛抗藥性結核菌 ) XDR-TB 的出現無異使結核病防治上更加困難，治療上比 MDR-TB 更為棘手，一旦被感染，其治療成功率有可能會降至 50% 以下 廣泛抗藥性結核菌 美國疾病管制中心和世界衛生組織 於2006年初發出警告，一種全新、致命性高的廣泛抗藥性結核菌正在全球擴散。 2006年8月在加拿大多倫多舉行的「國際世界愛滋病會議」(International World AIDS Confer