Infect Chemother.  2013 Dec;45(4):367-374. 10.3947/ic.2013.45.4.367.

Medical Treatment of Pulmonary Multidrug-Resistant Tuberculosis

• Shim TS
• Jo KW

• KMID: 2170440
• DOI: http://doi.org/10.3947/ic.2013.45.4.367

Abstract

Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the high toxicity of second-line drugs and the longer treatment duration required compared with drug-susceptible TB. The efficacy of treatment for MDR-TB is poorer than that 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 4 second-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 levofloxacin and 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 given for shorter durations (9-12 months) for MDR-TB are under investigation.

Keyword

Tuberculosis; Multidrug-resistant; Therapeutics; Extensively drug-resistant tuberculosis

MeSH Terms

Clofazimine
Cycloserine
Drug Resistance
Extensively Drug-Resistant Tuberculosis
Fluoroquinolones
Kanamycin
Levofloxacin
Linezolid
Prothionamide
Pyrazinamide
Tuberculosis
Tuberculosis, Multidrug-Resistant*
World Health Organization
Clofazimine
Cycloserine
Fluoroquinolones
Kanamycin
Prothionamide
Pyrazinamide