Management of patients with multidrugresistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement
Christoph Lange, Ibrahim Abubakar, Jan-Willem C. Alffenaar, Graham Bothamley, Jose A. Caminero, Anna Cristina C. Carvalho, Kwok-Chiu Chang, Luigi Codecasa, Ana Correia, Valeriu Crudu, Peter Davies, Martin Dedicoat, Francis Drobniewski, Raquel Duarte, Cordula Ehlers, Connie Erkens, Delia Goletti, Gunar Gu¨nther, Elmira Ibraim, Beate Kampmann, Liga Kuksa, Wiel de Lange, Frank van Leth, Jan van Lunzen, Alberto Matteelli, Dick Menzies, Ignacio Monedero, Elvira Richter, Sabine Ru¨sch-Gerdes, Andreas Sandgren, Anna Scardigli, Alena Skrahina, Enrico Tortoli, Grigory Volchenkov, Dirk Wagner, Marieke J. van der Werf, Bhanu Williams, Wing-Wai Yew, Jean-Pierre Zellweger and Daniela Maria Cirillo for the TBNET
ERJ Express. Published on March 23, 2014 as doi: 10.1183/09031936.00188313
The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence. This document summarises the current knowledge on the prevention, diagnosis and treatment of adults and children with MDR/XDR-TB and their contacts, and provides expert consensus recommendations on questions where scientific evidence is still lacking.