世界卫生组织发布肺结核指南第四版

2011-11-01 00:00 来源:丁香园 作者:
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The  World  Health  Organization’s  Stop  TB  Department  has  prepared  this  fourthedition of Treatment of tuberculosis: guidelines, adhering fully to the new WHO proc-ess  for  evidence-based  guidelines.  Several  important  recommendations  are  beingpromoted in this new edition.

First,  the  recommendation  to  discontinue  the  regimen  based  on  just  2  months  ofrifampicin  (2HRZE/6HE)  and  change  to  the  regimen  based  on  a  full  6  months  ofrifampicin (2HRZE/4HR) will reduce the number of relapses and failures. This willalleviate patient suffering resulting from a second episode of tuberculosis (TB) andconserve patient and programme resources.

Second, this fourth edition confirms prior WHO recommendations for drug suscep-tibility testing (DST) at the start of therapy for all previously treated patients. Findingand  treating  multidrug-resistant  TB  (MDR-TB)  in  previously  treated  patients  willhelp  to  improve  the  very  poor  outcomes  in  these  patients.  New  recommendationsfor  the  prompt  detection  and  appropriate  treatment  of  (MDR-TB)  cases  will  alsoimprove  access  to  life-saving  care.  The  retreatment  regimen  with  first-lin e drugs(formerly called “Category 2” regimen) is ineffective in MDR-TB; it is therefore criti-cal to detect MDR-TB promptly so that an effective regimen can be started.

Third, detecting MDR-TB will require expansion of DST capacity within the contextof country-specific, comprehensive plans for laboratory strengthening. This fourthedition provides guidance for treatment approaches in the light of advances in lab-oratory  technology  and  the  country’s  progress  in  building  laboratory  capacity.  Incountries that use the new rapid molecular-based tests, DST results for rifampicin/isoniazid will be available within 1?2 days and can be used in deciding which regimenshould be started for the individual patient. Rapid tests eliminate the need to treat “inthe dark” during the long wait for results of DST by other methods (weeks for liquidmedia methods or months for solid media methods).

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编辑: 冯志华

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