Drugs for preventing tuberculosis in people at risk of multiple-drug-resistant pulmonary tuberculosis

  • Review
  • Intervention

Authors


Abstract

Background

The emergence and spread of multiple-drug-resistant tuberculosis (MDR-TB), caused by strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, is a potential threat to global tuberculosis control. Treatment is prolonged, expensive, more toxic than treatment of susceptible tuberculosis, and often unsuccessful. Experts are still undecided on the management of people exposed to MDR-TB.

Objectives

To evaluate antituberculous drugs given to people exposed to MDR-TB in preventing active tuberculosis.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (March 2009), CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to March 2009); EMBASE (1974 to March 2009), LILACS (1982 to March 2009), conference proceedings, and reference lists. We also contacted researchers and organizations.

Selection criteria

Randomized controlled trials comparing antituberculous drug regimens with an alternative antituberculous drug regimen, placebo, or no intervention given to people exposed to MDR-TB for preventing active tuberculosis.

Data collection and analysis

Two authors independently inspected titles and abstracts identified by the search in order to identify potentially relevant publications for inclusion and analysis.

Main results

No randomized controlled trials met the inclusion criteria.

Authors' conclusions

The balance of benefits and harms associated with treatment for latent tuberculosis infection in people exposed to MDR-TB is far from clear. Antituberculous drugs should only be offered within the context of a well-designed randomized controlled trial, or when people are given the details of the current evidence on benefits and harms, along with the uncertainties.

摘要

背景

用於針對具有罹患多重抗藥性肺結核風險之對象進行結核病預防的藥物

多重抗藥性結核病(multipledrugresistant tuberculosis;MDRTB) 係由至少具有isoniazid及rifampicin抗藥性之結核桿菌(mycobacterium tuberculosis)菌株所造成,其出現及傳播對於全球性之結核病控制而言是一種潛在之威脅。其治療較敏感性結核病需要更長時間、更昂貴、且毒性更高,並經常失敗。專家目前仍未決定對於接觸MDRTB者之處理方式。

目標

評估給予接觸MDRTB者之抗結核藥物來預防活動性結核病。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2006年1月)、 CENTRAL (Cochrane Library 2006, Issue 1)、 MEDLINE (1966年−2006年1月); EMBASE (1974年 – 2006年1月)、 LILACS (1982年−2006年1月)、研討會手冊,以及參考資料清單。我們也與相關機構及研究人員聯繫。

選擇標準

比較給予接觸MDRTB者以預防活動性結核病之抗結核藥劑與另一抗結核藥物治療、安慰劑、或無干預措施之隨機對照試驗。

資料收集與分析

由2名作者獨立檢驗檢索辨識出之篇名及摘要,以辨識潛在相關之出版文獻進行收錄及分析。

主要結論

並無任何隨機對照試驗符合收錄標準。

作者結論

對於接觸MDRTB者所進行之潛伏結核感染治療具有極為不明之利害平衡。抗結核藥物應僅在設計良好之隨機對照試驗中提供,或者是在已充分告知目前有關其效益及害處之證據以及其不確定性的情形下給予。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

並無有關預防接觸多重抗藥性肺結核(multipledrugresistant tuberculosis;MDRTB)者之潛伏性結核病發展成為活動性結核病之治療有效性的研究。MDRTB係由至少對常見TB藥物(isoniazid及rifampicin)具有抗藥性之結核桿菌(Mycobacterium tuberculosis)菌株所造成,其出現及傳播對於全世界的人類而言是一種威脅。潛伏性結核病(無活動性疾病之感染)之治療在數十年來皆為結核病控制的關鍵。然而,MDRTB仍正在散播並造成病患死亡。本證據回顧並未發現任何已針對接觸MDRTB者之潛伏性結核病治療進行其有效性評估之隨機對照試驗。目前,對於接觸MDRTB者所進行之潛伏結核感染治療具有極為不明之利害平衡。藥物治療應僅在設計良好之隨機對照試驗中提供,或者是在已充分告知目前有關其效益或害處之證據以及其不確定性的情形下給予。

Plain language summary

No trials on effectiveness of treatments to prevent latent tuberculosis from developing into active disease in people exposed to multiple-drug-resistant tuberculosis (MDR-TB)

The emergence and spread of MDR-TB, caused by strains of Mycobacterium tuberculosis resistant to at least the common drugs used for TB (isoniazid and rifampicin), is a threat to people worldwide. Treatment of latent tuberculosis (infection without active disease) has been a key component in tuberculosis control for several decades. However, MDR-TB is spreading and people are dying. This review of evidence found no randomized controlled trials that have assessed the effectiveness of treatments of latent tuberculosis infection in people exposed to MDR-TB. Currently the balance of benefits and harms associated with treatment for latent tuberculosis infection in people exposed to MDR-TB is far from clear. Drug treatments should only be offered within the context of a well-designed randomized controlled trial, or where people are given the details of the current evidence on benefits or harms, along with the uncertainties.

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