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Management of patients with multidrug-resistant tuberculosis
Res Ctr Borstel, Germany; Univ Lubeck, Germany; German Ctr Infect Res DZIF, Germany; Karolinska Inst, Sweden.
Radboud Univ Nijmegen, Netherlands.
Univ Groningen, Netherlands.
Homerton Univ Hosp, England; QMUL, England; London Sch Hyg and Trop Med, England.
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2019 (English)In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 23, no 6, p. 645-662Article in journal (Refereed) Published
Abstract [en]

The emergence of multidrug-resistant tuberculosis (MDR-TB; defined as resistance to at least rifampicin and isoniazid) represents a growing threat to public health and economic growth. Never before in the history of mankind have more patients been affected by MDR-TB than is the case today. The World Health Organization reports that MDR-TB outcomes are poor despite staggeringly high management costs. Moreover, treatment is prolonged, adverse events are common, and the majority of affected patients do not receive adequate treatment. As MDR-TB strains are often resistant to one or more second-line anti-TB drugs, in-depth genotypic and phenotypic drug susceptibility testing is needed to construct personalised treatment regimens to improve treatment outcomes. For the first time in decades, the availability of novel drugs such as bedaquiline allow us to design potent and well-tolerated personalised MDR-TB treatment regimens based solely on oral drugs. In this article, we present management guidance to optimise the diagnosis, algorithm-based treatment, drug dosing and therapeutic drug monitoring, and the management of adverse events and comorbidities, associated with MDR-TB. We also discuss the role of surgery, physiotherapy, rehabilitation, palliative care and smoking cessation in patients with MDR-TB. We hope that incorporating these recommendations into patient care will be helpful in optimising treatment outcomes, and lead to more MDR-TB patients achieving a relapse-free cure.

Place, publisher, year, edition, pages
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D) , 2019. Vol. 23, no 6, p. 645-662
Keywords [en]
MDR-TB; RESIST-TB; TBNET; TB; XDR-TB; personalised treatment
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:liu:diva-159275DOI: 10.5588/ijtld.18.0622ISI: 000476473700003PubMedID: 31315696OAI: oai:DiVA.org:liu-159275DiVA, id: diva2:1341142
Note

Funding Agencies|German Center for Infection Research (DZIF); Swedish Heart and Lung Foundation; Swedish Research Council; South African Medical Research Council; European Union (EDCTP)

Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07

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Schön, Thomas
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Division of Microbiology, Infection and InflammationFaculty of Medicine and Health Sciences
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