MDR-TB

1
MDR-TB

• Kai Blöndal
• KNCV Tuberculosis Foundation
• Warsaw, 2006

2
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• ??????? ???-??
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• - ????? ????????????, ?????? ?? ??????? ??
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4
?????????? ?????????? ??????? ???????? ?????
??????? ?????? Mycobacterium tuberculosis
???????? ??????????? ?????????
?????????? 10-8
?????????, ????????????, ?????????, ?????????, ???? 10-6
????????, ???????????, ????????, ?????????, ??????????, ?????????? 10-3
5
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• 3 ????????? ?????? ???????????????????
  ?????????? (D.A.Mitchison 1985)
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6
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  ???????? ???????? ??????????? ???? (??????????)

7
????? ???????????? ?????????? (examined by
Jindany and others 1980)

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???????? ???? ???????? ??? ???-?? (2006-2015)

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12
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13
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14
??? ???????? ??????? ????????, 2006
??? ???????? ??????? 40 ????? 22 ? ??? ?
?????????? ??ATM
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16
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• ? ?????? ??????????? ?????? - ???????????? 77
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17
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18
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19
????????? ????????? ??? ???-?? (1)
??????????????? ????????? ?? ????? ??? ?? ??????????? ?????? ?? ???????? ????????? ??????????. ??? ???????? ????????? ???? ? ?? ? ?????????.
????????? ????????? ?? ?? ??????????? (??? ??????????? ?????? ???? ??????????? ???-??). ????? ??? ??????? ??????? ???????????? ?? ???????? ??????? ???????
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20
????????? ????????? ??? ???-?? (2)
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21
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22
???????? ???????? ??? ????????????? ????
????????? (1)

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• ?? ?? ?????????? ? 100 ???????? ???????????? ???
  ?????????????? ??????????. ???? ????? ??????????
  ?? ????? 4-? ??????????. ???? ??????? ?????? ?
  ?????????? ??????????? ??? 5 ?? 7 ??????????

23
???????? ???????? ??? ????????????? ????
????????? (2)

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24
?????????? ?????????? ?? ???????? ????????????
1. ?????? ??? ?????????? ????????? ????????? ???????????
2. ??????????-?????? ???????????? ????????? ???????? ??????????? ????????
3. ???????????? ?????????????? ??????????????????????? ??????????????????????????? ?????????????
4. ???????? ??????????????-?? ????????? ??????????? ?????????? ????????? ???? ??????????
5. ???????? ???????????? ?????????? ???????????/??????????? ??????? ????????????? ?????????
25
?????????? ????

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  ?????, ?? 6 ??????? ?? ?? ????? ?? 4 ??????
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• ???????????? ????????? ?????????????????
  ?????????? (3 ???? ? ??????? ????? ?????????
  ??????? ???????????? ????????? ???????? 2-3
  ???????)
• ????????? ????????????? ?? ?????, ?? 3 ????????
  ??????????? ???????????

26
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  ?? ???????
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  ????????? ????????

27
?????????? ????????? ??? ???-?? (1)
?????? ??????????? ???????, ??? ??????????????
?????? ?????? ???????? - ?? ????? ?? ?????? ?????? ?? ?????????, ???? ?????? 2-3 ??????.
???????????? ????????????? ?? ?????????? ? ??????? DOT- ??????
?????? ?????????? ?? ?????? ?? ??????? ?? ?????????? ?????????????????, ? ????? ?????? 2 ?????? ?? ????? ?????????
?????????????? ?????? ??????? ?????? ?????? 6 ???????
28
?????????? ? ??? ????????? ??? ???-?? (2)
?????? ??????????? ???????, ??? ??????????????
????????? ? ????????? ????? ???????? ???????? ???? ????????? ????????? ?/?
????? ? ????????? ????? ???????? ???? ????????? ????????? ?/?
??????????? ?????? 6 ???????, ???? ????????? Et/Pt ?/??? PAS ?? ???????? ?? ???????? ???????????????
????????? ???????? ? ????????? ????? ?????????? ????????????? ?? ???????, ??? ????????? Z ???????? ??? ?? ????? ????? ?? ???????
29
References

1. American Thoracic Society. Diagnostic Standards
   and Classification of Tuberculosis in Adults and
   Children. Am J Respir Crit Care Med Vol 161.pp
   1376-1395, 2000
2. Michael D.Iseman. A Clinicians guide to
   Tuberculosis. Lippincott WilliamsWilkins, USA,
   2000
3. Guidelines for the programmatic management of
   drug-resistant tuberculosis. World Health
   Organization, WHO/HTM/TB/2006.361
4. Treatment of Tuberculosis Guidelines for
   National Programmes. Third edition. World Health
   Organization, Geneva, 2003 (document
   WHO/CDS/TB/2003.313).
5. American Thoracic Society/Centers for Disease
   Control. Diagnostic standards and classification
   of tuberculosis. Am Rev Respir Dis 1990 142
   725-735
6. Hans L. Rieder. Epidemiologic Basis of
   Tuberculosis Control, International Union Against
   Tuberculosis and Lung Diseases , First edition,
   Paris, 1999

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References

• 7. Hans L. Rieder. Interventions for
  Tuberculosis Control and Elimination,
  International Union Against Tuberculosis and Lung
  Diseases, Paris, 2002
• 8. WHO/IUATLD. Anti-tuberculosis Drug
  resistance in the World. 1st Report. Geneva,
  1997. WHO/TB/97.229
• 9. Mitchinson DA. The action of antituberculosis
  drugs in short-course chemotherapy. Tubercle
  1985 66 219-25
• 10. The PIH Guide to the Medical Management of
  Multidrug-Resistant Tuberculosis, Partners in
  Health, 2003, USA
• 11. William N.Rom, Stuart M.Garay. Tuberculosis.
  Second edition, Philadelphia, 2004
• 12. Management of tuberculosis a guide for low
  income countries, Fifth edition. Paris,
  International Union Against Tuberculosis and Lung
  Disease, 2000