二线注射剂治疗耐多药结核病的现状与思考

Current knowledge and future prospects on the treatment of multidrug-resistant tuberculosis with second-line injectable agents

2018年12月WHO发布了《耐多药和利福平耐药结核病治疗指南(2018年)》,对既往推荐的化疗方案进行了多项更新。其中对长程治疗方案进行药品选择时不再优先考虑选用二线注射剂,主张全口服抗结核药品,弱化了二线注射剂的作用;而对9~12个月标准短程治疗方案,则建议运用于符合条件的患者,并且需要每日使用注射剂药品至少4个月,强调了二线注射剂的作用。基于此,笔者就我国治疗耐多药结核病常用的二线注射剂药品的种类及一般选药原则、耐药机制、临床疗效、不良反应和地位变化等问题进行论述和说明,期望进一步加强对二线抗结核药品注射剂的认识并使其得到合理使用。

WHO Treatment guidelines for multidrug- and rifampicin-resistant tuberculosis (2018 update) was issued in late 2018 to improve MDR/RR-TB care, in which a new all-oral 20-month treatment regimen is now proposed, prioritising oral drugs over injectables. A shorter MDR-TB regimen of 9-12 months was recommended to use instead of the longer regimens under some specific circunstances, including the daily use of second-line injec-table agents for at least 4 months. Under the background, we review the drug resistance mechanism, clinical effectiveness, adverse reaction and role change of second-line injectable agents commonly used in the treatment of MDR-TB in China and address the rational use of second line injection.