Tuberculosis Dotaz Zobrazit nápovědu

Národní referenční laboratoř pro mykobakterie (NRLM) Státního zdravotního ústavu v Praze, působící jako spolupracující referenční centrum Světové zdravotnické organizace (SZO), se v letech 1995-1996 zúčastnila globálního projektu surveillance lékove rezistence a byla pověřena vypracováním národní studie. Metodou proporčního testu podle Canetti-Grosseta byla v NRLM ověřena citlivost reprezentativního vzorku 416 kmenů M. tuberculosis. Vylučování rezistentního M. tuberculosis bylo zjištěno u 17 nemocných, 12 mužů a 5 žen. V rámci studie byly nalezeny pouze 2 typy rezistence, a to jednak monorezistence na izoniazid u 12 osob (2,9 %), jednak multirezistence na všechny 4 testované léky (t. j. na izoniazid, streptomycin, etambutol a rifampicin) u 5 osob (1,2 %). Iniciální rezistence na izoniazid byla prokázána u 13 (3,3 %) nemocných, na streptomycin, etambutol a rifampicin shodně u 3 nemocných (0,9 %). Procentuální hodnoty získané rezistence dosáhly u streptomycinu, etambutolu i rifampicinu 8,7 %, u izoniazidu 17,4 % a byly tedy v souladu s hodnotami nacházenými v dalších evropských státech. Za podstatné je nutno považovat zjištění relativně vysokého procenta kmenů se získanou rezistencí na izoniazid. Jako závažné lze hodnotit i nálezy multirezistentních kmenů M. tuberculosis.

The National Reference Laboratory for Mycobacteria (NRLM) of the National Institute of Public Health in Prague as a WHO collaborating reference centre took part in a global project of drug resistance surveillance conducted in 1995-1996. Throughout 1995, NRLM tested a representative sample of 416 M. tuberculosis strains by the Canetti-Grosset proportion method. Excretion of resistant M. tuberculosis was recorded in 17 patients, 12 males and 5 females. Only two types of resistance were found with in this study: monoresistance to isoniazid in 12 individuals (2,9 %) and multiresistance to all 4 drugs tested, i. e. isoniazid, rifampicin, ethambutol and streptomycin, in 5 individuals (1,2 %). Initial resistance to isoniazid was 3,3 % and that to streptomycin, ethambutol and rifampicin was 0,9 % for each of them. The percentage of acquired resistance to streptomycin, ethambutol and rifampicin was 8,7 % for each of them and that to isoniazid reached 17,4 % which was consistent with the data found in other European countries. The finding of a relatively high percentage of the acquired resistance to isoniazid is indicative of the urgent need for reconsidering whether isoniazid monotherapy or prophylaxis is justified and necessary. Serious are also the findings of multiresistant M. tuberculosis strains.

MeSH
antituberkulotika aplikace a dávkování škodlivé účinky MeSH
imunitní dozor MeSH
léková rezistence MeSH
multirezistentní tuberkulóza MeSH
Mycobacterium tuberculosis mikrobiologie účinky léků MeSH
Geografické názvy
Česká republika MeSH

Článek

Availability and costs of medicines for the treatment of tuberculosis in Europe

METHODS: We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility ...

Clinical microbiology and infection. 2023 ; 29 (1) : 77-84. [pub] 20220810

Clin Microbiol Infect
ISSN 1469-0691
Medvik
Zdroj

OBJECTIVES: To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries. METHODS: We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries. RESULTS: Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum-maximum, €15-152), €764 (minimum-maximum, €542-15152), and €8709 (minimum-maximum, €7965-11759) in middle-income countries (n = 12) and €280 (minimum-maximum, €78-1084), €29765 (minimum-maximum, €11116-40584), and €217591 (minimum-maximum, €82827-320146) in high-income countries (n = 29), respectively. DISCUSSION: In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis.

MeSH
antituberkulotika terapeutické užití MeSH
extenzivně rezistentní tuberkulóza * mikrobiologie MeSH
lidé MeSH
mikrobiální testy citlivosti MeSH
multirezistentní tuberkulóza * farmakoterapie mikrobiologie MeSH
Mycobacterium tuberculosis * MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH
Geografické názvy
Evropa MeSH

Kolekce

Publikováno

Filtry

Tuberculosis Dotaz Zobrazit nápovědu

Tuberculosis Dotaz Zobrazit nápovědu

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