Τίτλος:
Drug resistance in patients with tuberculous pleural effusions
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Purpose of review
To summarize data regarding categories, detection methods, prevalence
and patterns of drug resistance among patients with tuberculous pleural
effusion (TPE) and to comment on the management of suspected
drug-resistant TPE.
Recent findings
Pleural and pulmonary tuberculosis (TB) present similar patterns of drug
resistance. Approximately 10% and 6-10% of pleural Mycobacterium
tuberculosis isolates are resistant to at least one first-line anti-TB
drug or at least isoniazid, respectively. The prevalence of
multidrug-resistant-pleural and extensively drug-resistant-pleural TB is
1-3% and 0-1%, respectively.
Summary
Although guidelines suggest the empirical standard anti-TB regimen (i.e.
2 months of isoniazid, rifampicin, pyrazinamide and ethambutol followed
by 4 months of isoniazid and rifampicin) for TPE treatment, the data
regarding drug resistance among TPE patients are limited. The few
studies examining the issue report a notable drug resistance. In
suspected drug-resistant TPE, every effort is warranted to isolate M.
tuberculosis to perform drug susceptibility testing and provide guided
therapy. For this purpose, the use of cultures or molecular methods with
pleural biopsies is superior to their use in pleural fluid. If still M.
tuberculosis cannot be detected, prolonged administration of ethambutol
with isoniazid and rifampicin during the continuation phase of treatment
might be considered.
Συγγραφείς:
Skouras, Vasileios S.
Kalomenidis, Ioannis
Περιοδικό:
Current Opinion in Pulmonary Medicine
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
drug susceptibility testing; drug-resistance; pleural isolates;
pleuritis; tuberculous pleural effusion
DOI:
10.1097/MCP.0000000000000483
