The Lancet Respiratory Medicine Commission: 2019 update: epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant and incurable tuberculosis
| Autor: | Keertan Dheda, Tawanda Gumbo, Gary Maartens, Kelly E Dooley, Megan Murray, Jennifer Furin, Edward A Nardell, Robin M Warren, Aliasgar Esmail, Edward Nardell, Leslie London, Erica Lessem, Jason Limberis, Grant Theron, Ruth McNerney, Stefan Niemann, David Dowdy, Annelies Van Rie, Jotam G Pasipanodya, Camilla Rodrigues, Taane G Clark, Frik A Sirgel, H Simon Schaaf, Kwok Chiu Chang, Christoph Lange, Payam Nahid, Bernard Fourie, Norbert Ndjeka, Andrew Nunn, GB Migliori, Zarir F Udwadia, C Robert Horsburgh, Gavin J Churchyard, Dick Menzies, Anneke C Hesseling, James A Seddon, Marcus Low, Salmaan Keshavjee, Eric Nuermberger, Helen McIlleron, Kevin P Fennelly, Amina Jindani, Ernesto Jaramillo, Nesri Padayatchi, Clifton E Barry |
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| Přispěvatelé: | Lancet Respiratory Medicine drug-resistant tuberculosis Commission group |
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Tuberculosis Antitubercular Agents Disease 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Pharmacotherapy Tuberculosis diagnosis Tuberculosis Multidrug-Resistant Pulmonary Medicine medicine Humans 030212 general & internal medicine Dosing Diarylquinolines Intensive care medicine Oxazoles Societies Medical business.industry Linezolid medicine.disease Regimen 030228 respiratory system chemistry Nitroimidazoles Pretomanid Drug Therapy Combination Human medicine Periodicals as Topic Bedaquiline business |
| Zdroj: | The lancet respiratory medicine |
| ISSN: | 2213-2600 |
| DOI: | 10.1016/s2213-2600(19)30263-2 |
| Popis: | The Lancet Respiratory Medicine Commission on drug-resistant tuberculosis was published in 2017, which comprehensively reviewed and provided recommendations on various aspects of the disease. Several key new developments regarding drug-resistant tuberculosis are outlined in this Commission Update. The WHO guidelines on treating drug-resistant tuberculosis were updated in 2019 with a reclassification of second line anti-tuberculosis drugs. An injection-free MDR tuberculosis treatment regimen is now recommended. Over the past 3 years, advances in treatment include the recognition of the safety and mortality benefit of bedaquiline, the finding that the 9-11 month injectable-based 'Bangladesh' regimen was non-inferior to longer regimens, and promising interim results of a novel 6 month 3-drug regimen (bedaquiline, pretomanid, and linezolid). Studies of explanted lungs from patients with drug-resistant tuberculosis have shown substantial drug-specific gradients across pulmonary cavities, suggesting that alternative dosing and drug delivery strategies are needed to reduce functional monotherapy at the site of disease. Several controversies are discussed including the optimal route of drug administration, optimal number of drugs constituting a regimen, selection of individual drugs for a regimen, duration of the regimen, and minimal desirable standards of antibiotic stewardship. Newer rapid nucleic acid amplification test platforms, including point-of-care systems that facilitate active case-finding, are discussed. The rapid diagnosis of resistance to other drugs, (notably fluoroquinolones), and detection of resistance by targeted or whole genome sequencing will probably change the diagnostic landscape in the near future. |
| Databáze: | OpenAIRE |
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