肺结核卷土重来

好几代的医生、政客和公共卫生官员都竭力和肺结核(TB)作斗争。但在取得胜利若干年后,TB正卷土重来。发展中国家自1992年以来的TB发病率增加起初是由于HIV。然而,随着时间的推移,这种病患增多背后的其他因素,比如移民和一种具有特别的抗药性的TB也开始显现。

世界卫生组织已经制定了一套对付TB卷土重来的战略,其中包括一种标准化的疗程。该疗程具体规定了适用药物、剂量和治疗的时间。不幸的是,多种药物抗药性肺结核(MDR-TB)使得TB对传统的isoniazid和rifampicin产生抗药性,从而给我们带来了一个严峻的挑战:因为传统治疗方式疗效减弱,而该疾病还在继续传播。

另外,治疗得不彻底的TB会产生对多种药物的抗药性,因此治疗失败既可能是MDR-TB的成因,也可能是其结果。这种情况凸现了当前我们需要一种强有力的制度来治疗TB的必要性。同时我们还需要一种更为复杂的战略来控制这种疾病,该战略能尽可能多地治愈患者,防止获得性的抗药性并降低感染率。世界卫生组织推荐了一种“直接观察下的治疗战略”(DOTS),并设定了70%的传染性病例最低确诊率和85%的最低治愈率。

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