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다제내성결핵의 진단과 치료

Diagnosis and Treatment of Multidrug-Resistant Tuberculosis

심태선
대한내과학회 (The Korean Association Of Internal Medicine)|2015.05|대한내과학회지 (The Korean Journal of Medicine)|제88권 제5호|pp. 509-517|DOI http://dx.doi.org/10.3904/kjm.2015.88.5.509

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키워드

Treatment진단치료DiagnosisMultidrug-resistant tuberculosis다제내성결핵
주제분류내과학

초록

신속한 MDR-TB의 진단 및 성공률 높은 치료법의 개발은전 세계적으로 결핵을 퇴치하기 위한 중요한 전략 중의 하나이다. 배양을 이용한 전통적인 DST에 추가하여 신속하게결과를 확인할 수 있는 유전자형 검사법을 적극적으로 활용하여야 하며, 특히 약제내성의 위험인자가 있는 경우에는 더욱 그러하다. 새로운 항결핵약제의 개발, 기존의 타 목적으로 사용하던 약제의 결핵치료제로의 사용, 기존 항결핵약제의 용량의 변경 등과 함께 이러한 약제들을 병합하여 MDR-TB의 치료에 최적화된 표준치료법을 개발하는 것도매우 중요하다.

Abstract

Despite global efforts to control tuberculosis (TB), multidrug-resistant TB (MDR-TB) is still a serious problem worldwide. The diagnosis of MDR-TB is based on mycobacterial culture followed by drug susceptibility testing, with results available in weeks to months. This requirement calls for rapid direct tests, especially genotypic tests, in which specimens are amplified directly for the detection of MDR-TB. The treatment of MDR-TB is challenging because of the high toxicity of second-line drugs and the longer treatment duration required compared to drug-susceptible TB. The selection of drugs in MDR-TB is based on the treatment history, drug susceptibility results, and TB drug resistance patterns in each region. Recent World Health Organization guidelines recommend the use of at least four second-line drugs (i.e., a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid) in addition to pyrazinamide. Kanamycin is the initial choice of an injectable drug, and newer fluoroquinolones include levofloxacin and moxifloxacin. For extensively drug-resistant TB, group 5 drugs such as linezolid and clofazimine need to be included. New drugs such as delamanid and bedaquiline have recently been approved for treating MDR-TB and other agents with novel mechanisms of action that can be given for shorter durations (6-12 months) for MDR-TB are under investigation.

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