PDF(Sci-hub)
Abstract：
New evidence and knowledge about the clinical management of drug-resistant tuberculosis (TB) in the last 3 years, makes it necessary to update the recent guideline published by SEPAR in 2017, mainly in relation to new diagnostic methods, drug classification, and regimens of treatment recommended to treat patients with isoniazid-resistance TB, rifampicin resistance TB and multidrug-resistant TB. With respect to tuberculosis diagnosis, we recommend the use of rapid molecular assays that also help to detect mutations associated with resistance. In relation to the treatment of multidrug-resistant TB we prioritize effective all-oral shorter treatment regimens including bedaquiline, a fluoroquinolone (levofloxacin or moxifloxacin), bedaquiline and linezolid, instead of the previously recommended short-course treatment with aminoglycosides and other less effective and more toxic drugs. The design of these regimens (initial schedule and changes in the regimen if necessary) should be made in accordance with drug-resistant TB experts; the treatment should be the responsibility of personnel with experience in the treatment of TB and in TB units guaranteeing the follow-up of the treatment and the management of drugs adverse effects.
摘要：
在过去的3年中，有关耐药结核病（TB）的临床管理的新证据和知识，这使得有必要更新SEPAR在2017年发布的最新指南，主要涉及新的诊断方法，药物分类，以及推荐用于治疗异烟肼耐药结核病患者的治疗方案，利福平耐药结核病和耐多药结核病。关于结核病的诊断，我们建议使用快速分子检测方法，这也有助于检测与耐药性相关的突变。关于耐多药结核病的治疗，我们优先考虑有效的全口服短期治疗方案，包括bedaquiline，氟喹诺酮（左氧氟沙星或莫西沙星），贝达奎林和利奈唑胺，而不是以前推荐的使用氨基糖苷类和其他效果较差和毒性更大的药物的短期治疗。这些方案的设计（初始方案和必要时更改方案）应根据耐药结核病专家进行；治疗应由具有结核病治疗经验的人员和结核病单位负责，以确保治疗的随访和药物不良反应的管理。
