title: [Management of multidrug-resistant tuberculosis].
abstract: The emergence of drug-resistant TB in many countries has become a major public health problem and an obstacle to effective tuberculosis control. Multidrug-resistant tuberculosis (MDR-TB), which is most often the result of poor adherence, is a particularly dangerous form of tuberculosis because it is caused by bacilli resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs. Techniques for rapid diagnosis of resistance have greatly improved the care of patients by allowing early treatment which remains complex and costly establishment, and requires skills and resources. The treatment is not standardized but it includes in all cases attack phase with five drugs (there must be an injectable agent and a fluoroquinolone that form the basis of the regimen) for eight months and a maintenance phase (without injectable agent) with a total duration of 20 months on average. Surgery may be beneficial as long as the lesions are localized and the patient has a good cardiorespiratory function. Evolution of MDR-TB treated is less favorable than tuberculosis with germ sensitive. The cure rate varies from 60 to 75% for MDR-TB, and drops to 30 to 40% for XDR-TB. Mortality remains high, ranging from 20 to 40% even up to 70-90% in people co-infected with HIV.
authors.affiliation: Service de pneumologie, hôpital A.-Mami, Ariana, 2080 Tunis, Tunisie. Electronic address: fatma.tritar@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Tritar
authors.affiliation: Service de pneumologie, hôpital A.-Mami, Ariana, 2080 Tunis, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Daghfous
authors.affiliation: Service de pneumologie, hôpital A.-Mami, Ariana, 2080 Tunis, Tunisie.
authors.forename: S
authors.initials: S
authors.lastname: Ben Saad
authors.affiliation: Service de bactériologie, hôpital A.-Mami, Ariana, 2080 Tunis, Tunisie.
authors.forename: L
authors.initials: L
authors.lastname: Slim-Saidi
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy; D006801:Humans; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents
keywords: MDR-TB; Multidrug-resistant tuberculosis; Traitement; Treatment; Tuberculose; Tuberculose multirésistante; Tuberculosis; XDR-TB; XDR–TB