背景:美国胸科学会,美国疾病控制和预防中心,欧洲呼吸学会,和美国传染病学会共同发起了关于耐药结核病(DR-TB)治疗的新实践指南。该文件包括有关耐多药结核病(MDR-TB)以及耐异烟肼但对利福平敏感的结核病的治疗建议。方法:发表系统综述,荟萃分析,以及来自12,030名患者的新的个体患者数据荟萃分析,在50项研究中,本指南使用了25个已确诊的利福平耐药结核病国家.元分析方法包括倾向得分匹配以减少混淆。每个建议都由一个专家委员会讨论,筛选利益冲突,根据建议的分级,评估,发展,和评估(等级)方法。结果:21人,干预,比较器,结果问题得到了解决,生成25个基于等级的建议。证据的确定性被判定为非常低,因为数据来自观察性研究,观察性研究具有显著的随访失败和比较组之间背景治疗方案的不平衡.介绍了耐多药结核病管理的良好做法。在证据审查的基础上,还提供了用于建立MDR-TB治疗方案的临床策略工具.结论:对方案中药物的选择和数量提出了新的建议,密集和延续阶段的持续时间,以及注射药物对耐多药结核病的作用。根据这些建议,可以组装耐多药结核病的有效全口服治疗方案.还提供了关于手术在耐多药结核病治疗中的作用以及接触耐多药结核病和耐异烟肼结核病治疗中的作用的建议。
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice
guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this
guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.