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Multi and extensively drug-resistant pulmonary tuberculosis: advances in diagnosis and management

Pontali, Emanuelea; Visca, Dinab; Centis, Rosellac; D’Ambrosio, Liac,d; Spanevello, Antoniob,e; Migliori, Giovanni, Battistac

Current Opinion in Pulmonary Medicine: May 2018 - Volume 24 - Issue 3 - p 244–252
doi: 10.1097/MCP.0000000000000477
INFECTIOUS DISEASES: Edited by Alimuddin Zumla and Michael S. Niederman

Purpose of review Multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR)-TB epidemics are key obstacles towards TB control and elimination.

Recent findings Diagnosis of MDR/XDR-TB is difficult and requires several weeks. New diagnostic tools are being tested and proposed allowing for shorter time to diagnosis and reduced delays in starting an adequate treatment regimen. MDR/XDR-TB treatment strategies are currently on an evolving stage. New shortened treatments based on the recommended ’Bangladesh regimen’ or on the newer anti-TB drugs, delamanid and bedaquiline may represent part of the future scenario. In addition, more information on safety and efficacy of delamanid and bedaquiline has been published, allowing to better position these drugs. Recent information on treatment regimens for the paediatric age, with or without delamanid or bedaquiline, has become available. This is of great help in designing safer and more efficacious regimens for the treatment of MDR/XDR-TB in children and adolescents.

Summary The accessibility, sustainability and scale-up of new diagnostic technologies are lagging behind and more efforts are needed. In addition, we need high-quality information on safety and efficacy of various combinations of drugs to obtain the best possible regimens to treat the largest possible proportion of patients.

aDepartment of Infectious Diseases, Galliera Hospital, Genoa

bRespiratory Medicine Unit

cWHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy

dPublic Health Consulting Group, Lugano, Switzerland

eDepartment of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy

Correspondence to Giovanni Battista Migliori, MD, WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, IRCCS, via Roncaccio 16, 21049 Tradate (VA), Italy. Tel: +39 0331829404; e-mail: giovannibattista.migliori@icsmaugeri.it

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