Medical Treatment of Pulmonary Multidrug-Resistant Tuberculosis
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Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the high toxicity of second-line drugs and thelonger treatment duration required compared with drug-susceptible TB. The efficacy of treatment for MDR-TB is poorer thanthat for drug-susceptible TB. The selection of drugs in MDR-TB is based on previous treatment history, drug susceptibility results,and TB drug resistance patterns in the each region. Recent World Health Organization guidelines recommend the use of least 4second-line drugs (a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid)in addition to pyrazinamide. The kanamycin is the initial choice of injectable durgs, and newer fluoroquinolones include levofloxacinand moxifloxacin. For MDR-TB, especially cases that are extensively drug-resistant, group 5 drugs such as linezolid,clofazimine, and amoxicillin/clavulanate need to be included. New agents with novel mechanisms of action that can be givenfor shorter durations (9-12 months) for MDR-TB are under investigation.
Abstract
Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the high toxicity of second-line drugs and thelonger treatment duration required compared with drug-susceptible TB. The efficacy of treatment for MDR-TB is poorer thanthat for drug-susceptible TB. The selection of drugs in MDR-TB is based on previous treatment history, drug susceptibility results,and TB drug resistance patterns in the each region. Recent World Health Organization guidelines recommend the use of least 4second-line drugs (a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid)in addition to pyrazinamide. The kanamycin is the initial choice of injectable durgs, and newer fluoroquinolones include levofloxacinand moxifloxacin. For MDR-TB, especially cases that are extensively drug-resistant, group 5 drugs such as linezolid,clofazimine, and amoxicillin/clavulanate need to be included. New agents with novel mechanisms of action that can be givenfor shorter durations (9-12 months) for MDR-TB are under investigation.
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