Kekkaku : [Tuberculosis]
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Kekkaku : [Tuberculosis] · Jan 2011
Management of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis: current status and future prospects.
Resistance in Mycobacterium tuberculosis arises from man-made selection of genetic mutants that result from spontaneous chromosomal alterations. Thus, drug-resistant tuberculosis (TB) is generally due to inappropriate treatment regimen, poor drug quality, erratic drug supply and poor patient adherence to treatment, reflecting failure in the implementation of an effective TB control programme. Multidrug-resistant TB (MDR-TB) usually denotes bacillary resistance to at least isoniazid and rifampicin. ⋯ Further exploration is required regarding the use of immunotherapy. The recent emergence of extensively drug-resistant TB (XDR-TB), representing MDR-TB with additional bacillary resistance to fluoroquinlones and one or more of the second-line injectable drugs -kanamycin, amikacin and capreomycin, threatens the global control of TB. Given the escalating size of the problem of MDR-TB and XDR-TB worldwide, gigantic instillation of resources is required for control of this formidable challenge, largely through more accurate and rapid drug susceptibility testing (especially for rifampicin and fluoroquinolone), regular drug-resistance surveillance, development of new antituberculosis drugs and other therapeutic modalities, intensive infection control, especially in HIV care settings, as well as strengthening of currently functioning DOTS and Drug-Resistance Programmes.