Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are generally thought to have high mortality rates. However, many cases can be treated with the right combination and rational use of available antituberculosis drugs. This Review describes the evidence available for each dr...

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Bibliographic Details
Published in:The Lancet infectious diseases Vol. 10; no. 9; pp. 621 - 629
Main Authors: Caminero, José A, Sotgiu, Giovanni, Zumla, Alimuddin, Migliori, Giovanni Battista
Format: Journal Article
Language:English
Published: London Elsevier Ltd 01.09.2010
Lancet Publishing Group
Elsevier Limited
Subjects:
Amikacin - therapeutic use
Antitubercular Agents - classification
Antitubercular Agents - standards
Antitubercular Agents - therapeutic use
Bacterial diseases
Biological and medical sciences
Capreomycin - therapeutic use
Drug Resistance, Multiple
Drugs
Ethambutol - therapeutic use
Extensively Drug-Resistant Tuberculosis - drug therapy
Fluoroquinolones - therapeutic use
Human bacterial diseases
Humans
Infectious Disease
Infectious diseases
Isoniazid - therapeutic use
Kanamycin - therapeutic use
Levofloxacin
Medical sciences
Ofloxacin - therapeutic use
Pyrazinamide - therapeutic use
Tuberculosis
Tuberculosis - drug therapy
Tuberculosis and atypical mycobacterial infections
Infection
Chemotherapy
Treatment
Tuberculosis
Multiple resistance
Bacteriosis
Mycobacterial infection
ISSN:1473-3099, 1474-4457, 1474-4457
Online Access:Get full text
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Summary:Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are generally thought to have high mortality rates. However, many cases can be treated with the right combination and rational use of available antituberculosis drugs. This Review describes the evidence available for each drug and discusses the basis for recommendations for the treatment of patients with MDR and XDR tuberculosis. The recommended regimen is the combination of at least four drugs to which the Mycobacterium tuberculosis isolate is likely to be susceptible. Drugs are chosen with a stepwise selection process through five groups on the basis of efficacy, safety, and cost. Among the first group (the oral first-line drugs) high-dose isoniazid, pyrazinamide, and ethambutol are thought of as an adjunct for the treatment of MDR and XDR tuberculosis. The second group is the fluoroquinolones, of which the first choice is high-dose levofloxacin. The third group are the injectable drugs, which should be used in the following order: capreomycin, kanamycin, then amikacin. The fourth group are called the second-line drugs and should be used in the following order: thioamides, cycloserine, then aminosalicylic acid. The fifth group includes drugs that are not very effective or for which there are sparse clinical data. Drugs in group five should be used in the following order: clofazimine, amoxicillin with clavulanate, linezolid, carbapenems, thioacetazone, then clarithromycin.
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ISSN:1473-3099
1474-4457
1474-4457
DOI:10.1016/S1473-3099(10)70139-0