The Lancet Respiratory Medicine Commission: 2019 update: epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant and incurable tuberculosis

Publication date: September 2019Source: The Lancet Respiratory Medicine, Volume 7, Issue 9Author(s): Keertan Dheda, Tawanda Gumbo, Gary Maartens, Kelly E Dooley, Megan Murray, Jennifer Furin, Edward A Nardell, Robin M Warren, Keertan Dheda, Tawanda Gumbo, Gary Maartens, Kelly E Dooley, Aliasgar Esmail, Megan Murray, Jennifer Furin, Edward Nardell, Leslie London, Erica Lessem, Jason Limberis, Grant TheronSummaryThe Lancet Respiratory Medicine Commission on drug-resistant tuberculosis was published in 2017, which comprehensively reviewed and provided recommendations on various aspects of the disease. Several key new developments regarding drug-resistant tuberculosis are outlined in this Commission Update. The WHO guidelines on treating drug-resistant tuberculosis were updated in 2019 with a reclassification of second line anti-tuberculosis drugs. An injection-free MDR tuberculosis treatment regimen is now recommended. Over the past 3 years, advances in treatment include the recognition of the safety and mortality benefit of bedaquiline, the finding that the 9–11 month injectable-based ‘Bangladesh’ regimen was non-inferior to longer regimens, and promising interim results of a novel 6 month 3-drug regimen (bedaquiline, pretomanid, and linezolid). Studies of explanted lungs from patients with drug-resistant tuberculosis have shown substantial drug-specific gradients across pulmonary cavities, suggesting that alternative dosing and drug delivery strategies are needed to redu...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research