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Regimens to treat multidrug-resistant tuberculosis: past, present and future perspectives
Article de revue scientifique   Open Access   Avec comité de lecture

Regimens to treat multidrug-resistant tuberculosis: past, present and future perspectives

Emanuele Pontali, Mario Raviglione, Giovanni Battista Migliori, Onno W. Akkerman, Jan-Willem Alffenaar, François-Xavier Blanc, Sergey Borisov, Daniela Maria Cirillo, Margareth Dalcolmo, Keertan Dheda, …
European Respiratory Review, Vol.28(152)
2019
PMCID: PMC9489134
PMID: 31142549

Résumé

Antitubercular Agents / administration & dosage* Antitubercular Agents / history History, 20th Century History, 21st Century Humans Treatment Outcome Tuberculosis, Multidrug-Resistant / drug therapy* Tuberculosis, Multidrug-Resistant / history Tuberculosis, Multidrug-Resistant / microbiology Diffusion of Innovation Drug Administration Schedule Drug Resistance, Multiple, Bacterial* Drug Therapy, Combination Extensively Drug-Resistant Tuberculosis / drug therapy Extensively Drug-Resistant Tuberculosis / history Extensively Drug-Resistant Tuberculosis / microbiology Forecasting
Over the past few decades, treatment of multidrug-resistant (MDR)/extensively drug-resistant (XDR) tuberculosis (TB) has been challenging because of its prolonged duration (up to 20–24 months), toxicity, costs and sub-optimal outcomes. After over 40 years of neglect, two new drugs (bedaquiline and delamanid) have been made available to manage difficult-to-treat MDR-/XDR-TB cases. World Health Organization (WHO) guidelines published in March 2019 endorsed the possibility of treating MDR-TB patients with a full oral regimen, following previous guidelines published in 2016 which launched a shorter regimen lasting 9–10 months. The objectives of this article are to review the main achievements in MDR-TB treatment through the description of the existing WHO strategies, to discuss the main ongoing trials and to shed light on potential future scenarios and revised definitions necessary to manage drug-resistant TB.

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