Skip Navigation


JAC Advance Access originally published online on July 28, 2004
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
54/3/593    most recent
dkh377v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (15)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Di Perri, G.
Right arrow Articles by Bonora, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Di Perri, G.
Right arrow Articles by Bonora, S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Journal of Antimicrobial Chemotherapy 2004 54(3):593-602; doi:10.1093/jac/dkh377
JAC vol.54 no.3 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved

Review

Which agents should we use for the treatment of multidrug-resistant Mycobacterium tuberculosis?

Giovanni Di Perri* and Stefano Bonora

Department of Infectious Diseases, University of Torino, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy

* Corresponding author. Tel: +39-011740388; Fax: +39-011744971; Email: di_perri{at}dealer.it

The inappropriate treatment of drug-susceptible tuberculosis can lead to the selection and transmission of multidrug-resistant tuberculosis (MDR-TB), indicating resistance to at least isoniazid and rifampicin. In the treatment of MDR-TB, residual first-line drugs, such as ethambutol, pyrazinamide and streptomycin must be appropriately combined with additional second-line drugs, guided by individual susceptibility patterns. The clinical pharmacology of these second-line antituberculous drugs is reviewed. Fluoroquinolones represent the only substantial therapeutic advance in the last 20 years. Many factors potentially affect the outcome of MDR-TB. Treatment adherence, prior exposure to antituberculous drugs, the number of drugs to which the infection is still susceptible and the time since the first diagnosis of tuberculosis are the most relevant. The management of MDR-TB requires considerable expertise. When initiating or revising therapy for MDR-TB, the process of selecting drugs should rely on prior treatment history, results of susceptibility testing and an evaluation of the patient's adherence. In making drug selection, we propose to follow a hierarchy based on the intrinsic activity against Mycobacterium tuberculosis and the clinical evidence of efficacy of the available active compounds.

Keywords: M. tuberculosis , multidrug-resistant tuberculosis , therapy , second-line agents


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J Antimicrob ChemotherHome page
R. C. Y. Chan, M. Hui, E. W. C. Chan, T. K. Au, M. L. Chin, C. K. Yip, C. K. W. AuYeang, C. Y. L. Yeung, K. M. Kam, P. C. W. Yip, et al.
Genetic and phenotypic characterization of drug-resistant Mycobacterium tuberculosis isolates in Hong Kong
J. Antimicrob. Chemother., May 1, 2007; 59(5): 866 - 873.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
L. Hall, J. A. Otter, J. Chewins, and N. L. Wengenack
Use of Hydrogen Peroxide Vapor for Deactivation of Mycobacterium tuberculosis in a Biological Safety Cabinet and a Room
J. Clin. Microbiol., March 1, 2007; 45(3): 810 - 815.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
G Barlow and D Nathwani
Is antibiotic resistance a problem? A practical guide for hospital clinicians
Postgrad. Med. J., November 1, 2005; 81(961): 680 - 692.
[Abstract] [Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.