Turkiye Klinikleri Journal of Medical Sciences

.: REVIEW
İlaca Dirençli Tüberkülozun Tedavisi
Treatment of Drug-Resistant Tuberculosis: Review
Doç.Orhan BAYLANa
aTıbbi Mikrobiyoloji Servisi, GATA Haydarpaşa Eğitim Hastanesi, İstanbul
Turkiye Klinikleri J Med Sci. 2012;32(3):788-804
doi: 10.5336/medsci.2011-24602
Article Language: TR
Full Text
ÖZET
İlaca dirençli tüberküloz (TB), kemoterapi uygulamaları sonunda ortaya çıkan, insan yapımı önemli bir klinik sorundur. Yaygın ilaca dirençli (YİD) TB, birinci-basamak anti-TB ilaçlardan izoniyazit ve rifampisin direncine [çok ilaca dirençli (ÇİD) TB tanımı] ek olarak herhangi bir florokinolona ve parenteral verilen ikinci-basamak anti-TB ilaçlardan en azından birisine direnç gelişmesi durumudur. YİD-TB'nin ortaya çıkışı, özellikle ÇİD-TB hastalarının tedavisini daha da önemli hâle getirmiştir. Son olarak dünyada henüz birkaç olguda saptanan tüm birinci ve ikinci-basamak anti-TB ilaçlara dirençli olan yeni bir TB formu, "tüm ilaçlara dirençli (TİD) TB" olarak tanımlanmıştır. ÇİD ve YİD-TB'li hastaların tedavisi, izoniyazit ve rifampisin kullanılamadığından, ikinci-basamak anti-TB ilaçların uzun süre ve gözetim altında kullanımını gerektirmektedir. ÇİD ve YİD-TB'li hastaların tedavisi, TB kültürünün yanı sıra, birinci ve ikinci-basamak anti-TB ilaç duyarlılık testlerini yapabilecek güvenilir laboratuvar hizmetleri ile birlikte, yeterli donanıma sahip kurumlarda deneyimli uzmanlar tarafından uygulanmalıdır. ÇİD ve YİD-TB'li hastaların tedavisinde mikroorganizmanın duyarlı olduğu bildirilmiş 4-6 ilaçtan oluşan çoklu ilaç rejimleri, en azından 18-24 ay süreyle kullanılmalıdır. Tedavi rejimi parenteral bir ilaç içermeli ve bu ilaç kültür negatifliği sağlandıktan sonra en az dört ay süreyle kullanılmaya devam edilmelidir. Bu derlemede, özellikle son yıllarda tekrar önem kazanan ÇİD ve yeni tanımlanan YİD-TB başta olmak üzere, ilaca dirençli TB formlarının tedavisinde kullanılan ilaçlar, bunların istenmeyen etkileri, tedavi prensipleri, tedavi takibi ile tedavi sonuçları üzerinde durulmuştur.

Anahtar Kelimeler: Mycobacterium tuberculosis; tüberküloz, çok ilaca dirençli tüberküloz; yaygın ilaca dirençli tüberküloz; antitüberküloz ajanları
ABSTRACT
Drug-resistant tuberculosis (TB) is a significant manmade problem resulting from chemotherapy use. Extensively drug-resistant (XDR) TB is the development of resistance against any fluoroquinolones and at least one of the injectable second line anti-TB drugs in addition to resistance against isoniazide and rifampicin, first line anti-TB drugs, (definition of multidrug-resistant-MDR-TB). Emergence of XDR-TB made treatment of MDR-TB patients much more significant. Finally, a novel TB form (extremely drug-resistant-XXDR-TB) that is resistant to all first and second line anti-TB drugs detected in a few cases worldwide is defined as "TB resistant to all drugs". Treatment of patients with MDR and XDR-TB requires long term and monitored use of second line anti-TB drugs as isoniazide and rifampicin cannot be used. Treatment of MDR and XDR-TB patients should be managed by experienced specialists in institutions that are adequately equipped and have reliable laboratories that may perform first line and second line anti-TB susceptibility tests besides TB culture. Multidrug regimens composed of 4-6 drugs to which the infecting microorganism is susceptible should be used for at least 18-24 months to cure patients with MDR and XDR-TB. Treatment regimen should include a parenteral drug and this drug should be continued to be used for at least four months after cultures become negative. This review includes drugs that are used for the treatment of drug resistant TB forms, mainly MDR that has regained importance recently and newly defined XDR-TB, adverse effects of the drugs, treatment principles, follow-up and outcomes of treatment.

Keywords: Mycobacterium tuberculosis; tuberculosis, multidrug resistant tuberculosis; extensively drug resistant tuberculosis; antituberculous agents

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30.03.2014

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