RESUMO
No disponible
Assuntos
Humanos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Mycobacterium tuberculosis/patogenicidade , Antituberculosos/uso terapêutico , Fatores de RiscoAssuntos
Antibióticos Antituberculose/uso terapêutico , Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Humanos , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
The classification of anti-tuberculosis (TB) drugs is important as it helps the clinician to build an appropriate anti-TB regimen for multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB cases that do not fulfil the criteria for the shorter MDR-TB regimen. The World Health Organization (WHO) has recently approved a revision of the classification of new anti-TB drugs based on current evidence on each drug. In the previous WHO guidelines, the choice of drugs was based on efficacy and toxicity in a step-down manner, from group 1 first-line drugs and groups 2-5 second-line drugs, to group 5 drugs with potentially limited efficacy or limited clinical evidence. In the revised WHO classification, exclusively aimed at managing drug-resistant cases, medicines are again listed in hierarchical order from group A to group D. In parallel, a possible future classification is independently proposed. The aim of this viewpoint article is to describe the evolution in WHO TB classification (taking into account an independently proposed new classification) and recent changes in WHO guidance, while commenting on the differences between them. The latest evidence on the ex-group 5 drugs is also discussed.
Assuntos
Antituberculosos/classificação , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Antituberculosos/uso terapêutico , Evolução Biológica , Monitoramento de Medicamentos , Humanos , Testes de Sensibilidade Microbiana , Organização Mundial da SaúdeRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Monitoramento Epidemiológico , Conferências de Consenso como Assunto , América Latina/epidemiologia , Síndromes de Imunodeficiência , Antirretrovirais/uso terapêutico , Sensibilidade e Especificidade , Biologia Molecular , Mycobacterium tuberculosis/isolamento & purificaçãoRESUMO
La posibilidad de erradicar la TB, probablemente la enfermedad que más daño ha causado a la especie humana, ha sido un sueño legítimo del hombre a lo largo de toda su historia. Este artículo trata de analizar la complejidad de la batalla entre Mycobacterium tuberculosis y la especie humana, intentado realizar un repaso de todos los conocimientos que se tienen sobre esta enfermedad y de lo más importante de lo que puede acontecer en el futuro. De todo lo expuesto en este artículo se puede concluir que, a pesar de que la especie humana tiene suficientes conocimientos para vencer la batalla a M. tuberculosis, importantes condicionantes, sobre todo sociales (pobreza, inmigración, VIH, multidrogo resistencias (MDR)), están favoreciendo la guerra lado del bacilo. Y que, incluso aplicando adecuadamente todos los buenos conocimientos adquiridos para el control de la TB (detección y curación de casos, quimioprofilaxis, vacunación BCG, etc), se tardaría aún varios siglos en poder conseguir la erradicación de la TB. Sólo la posibilidad de descubrir una vacuna 100% eficaz, o el descubrimiento de nuevas asociaciones antimicrobianas que pudiesen curar la TB en un plazo no superior a 15días, podría acelerar este ritmo hacia la erradicación. Pero, lamentablemente, no existen fundamentos que permitan soñar con que cualquiera de estas dos posibilidades pueda cumplirse en los próximos 10-20 años. Por lo tanto, el sueño de erradicar la TB es un sueño muy antiguo, pero, lamentablemente, aun muy lejano de poder conseguirse (AU)
The possibility to eradicate the TB, probably the illness that more damage has caused to the human species, it has been the man's legitimate dream along all its history. This article wants to analyze the complexity of the battle between Mycobacterium tuberculosis and the human species, trying to carry out a review of all the knowledge regarding this disease and of the most important things of what can happen in the future. Of all the topics exposed in this article we can conclude that, although the human species has enough knowledge to win the battle to M. tuberculosis, important conditions, mainly social (poverty, immigration, HIV, MDR), are favouring the war side of the bacillus. And that, even applying adequately all the good acquired knowledge for the control of the TB (detection and cure of cases, chemoprophy laxis, vaccination BCG, etc), it would take a long time, even several centuries, in being able to get the eradication of the TB. Only the possibility to discover a vaccine 100 effective%, or the discovery of new antimicrobial associations that can cure the TB in a term non superior to 15 days, could accelerate this rhythm toward the eradication. But, unfortunately, basis that allow to dream don't exist with which anyone of these two possibilities can be turned in next 10-20 years. Therefore, the dream of eradicating the TB is a very old dream, but, unfortunately, even very remote to be achieved (AU)
