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Facing multi-drug resistant tuberculosis

Sotgiu, Giovanni and Migliori, Giovanni Battista (2014) Facing multi-drug resistant tuberculosis. Pulmonary pharmacology & therapeutics , in press. ISSN 1094-5539. eISSN 1522-9629. Article.

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DOI: 10.1016/j.pupt.2014.04.006

Abstract

Multi-drug resistant tuberculosis (MDR-TB) is caused by Mycobacterium tuberculosis strains resistant to at least two of the most effective anti-tuberculosis drugs (i.e., isoniazid and rifampicin). Therapeutic regimens based on second- and third-line anti-tuberculosis medicines showed poor efficacy, safety, and tolerability profiles. It was estimated that in 2012 the multi-drug resistant tuberculosis incidence ranged from 300,000 to 600,000 cases, mainly diagnosed in the Eastern European and Central Asian countries. The highest proportion of cases is among individuals previously exposed to anti-tuberculosis drugs. Three main conditions can favour the emergence and spread of multi-drug resistant tuberculosis: the poor implementation of the DOTS strategy, the shortage or the poor quality of the anti-tuberculosis drugs, and the poor therapeutic adherence of the patients to the prescribed regimens.
Consultation with tuberculosis experts (e.g., consilium) is crucial to tailor the best anti-tuberculosis therapy.
New therapeutic options are necessary: bedaquiline and delamanid seem promising drugs; in particular, during the development phase they demonstrated a protective effect against the emergence of further resistances towards the backbone drugs. In the recent past, other antibiotics have been administered off-label: the most relevant efficacy, safety, and tolerability profile was proved in linezolid-, meropenem/clavulanate-, cotrimoxazole-containing regimens.
New research and development activities are needed in the diagnostic, therapeutic, preventive fields.

Item Type:Article
ID Code:9797
Status:In Press
Refereed:Yes
Uncontrolled Keywords:Mycobacterium tuberculosis, MDR-TB, XDR-TB, second-line drugs, elimination, stop TB strategy
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
Publisher:Academic Press / Elsevier
ISSN:1094-5539
eISSN:1522-9629
Deposited On:16 May 2014 12:25

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