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背景:从19世纪60年代开始,对结核病潜伏感染者(LTBI)使用异烟肼治疗已经被证明是有效、安全和便宜的,因此对于其他替代治疗方法的研究事实上也就终止了。现在耐多药结核(MDR-TB)广泛传播,但仍然没有数据能够为耐多药病人接触者的管理提供指导。方法:我们选取新病人中耐多药患病率>2%并且制定了耐多药结核病管理规划的国家作为调查对象。通过对这些国家的规划领导人和耐多药结核病项目的项目管理者进行调查,了解这些国家目前对于耐多药病人接触者的处理措施。结果:在符合调查条件的35个国家中,25(71%)个国家参加了此次调查;其中24(96%)个国家已经制定了管理结核病接触者的指南。在25个国家中,有19(76%)个国家经常或总是对结核病接触者进行评估,对结核病潜伏感染(LTBI)进行治疗。与之相反的是,10(40%)个国家报告已经制定了耐多药病人接触者的管理指南;11(44%)个国家经常或总是对耐多药结核接触者进行评价;9(36%)个国家对结核病潜伏感染(LTBI)进行治疗。仅有2个国家采用了治疗耐多药结核病人的方案。对于MDR-TB接触者不提供治疗的主要原因是缺乏证据和指南。结论:由于缺少以证据为基础的指南,现有的对耐多药结核病人接触者的管理措施缺乏一致性和有效性。因此急需寻找相关的证据来指导政策的制定。
Background. The use of isoniazid for the treatment of latent tuberculosis (LTBI) has been shown to be effective, safe and inexpensive since the 1860s and the study of other alternative therapies has virtually ceased. There is now widespread transmission of multidrug-resistant tuberculosis (MDR-TB), but there is still no data that can guide the management of multi-drug resistant patients. Methodology: We selected countries with countries that have a multidrug resistance multi-drug prevalence rate of> 2% in new patients and have developed a multidrug-resistant tuberculosis management plan. Through surveys of program leaders in these countries and project managers on multidrug-resistant tuberculosis programs, current treatment options for contacts with multidrug-resistant patients in these countries are known. Results: Twenty-five (71%) of the 35 countries that met the survey conditions participated in the survey; 24 (96%) of them had guidelines for managing TB contacts. Out of 25 countries, 19 (76%) countries regularly or always assess TB contacts to treat latent tuberculosis (LTBI). In contrast, 10 (40%) of countries reported that they had developed guidelines for the management of contacts with multidrug-resistant patients; 11 (44%) often or always assessed MDR-TB contacts; 9 ( 36%) countries treat latent tuberculosis (LTBI). Only two countries have adopted programs to treat MDR-TB patients. The main reason for not providing treatment for MDR-TB contacts is the lack of evidence and guidance. CONCLUSION: The lack of evidence-based guidance lacks the consistency and effectiveness of existing management measures for MDR-TB contacts. Therefore, urgent need to find relevant evidence to guide the formulation of policies.