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TUBERCULOSIS EXTENSAMENTE RESISTENTE EN LA ARGENTINA. NUESTRA EXPERIENCIA

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La información sobre seguridad, tolerabilidad y eficacia acerca de drogas potencialmente útiles en el tratamiento de la tuberculosis extensamente resistente es de extrema utilidad, no sólo para mejorar el pronóstico individual de estos pacientes sino también para controlar su diseminación.
abbate9_82710.jpg Autor:
Eduardo Abbate
Columnista Experto de SIIC

Institución:
Hospital de Enfermedades Infecciosas Francisco J Muñiz

Artículos publicados por Eduardo Abbate
Coautores
Marisa Vescovo* Mónica Cufré* Marcela Natiello** Ana García** Pablo González Montaner*** 
Médica, Hospital de Enfermedades Infecciosas Francisco J Muñiz, Buenos Aires, Argentina*
Médica, Instituto de Tisioneumonología "Prof.Dr.R.Vaccareza", Buenos Aires, Argentina**
Médico, Instituto de Tisioneumonología "Prof.Dr.R.Vaccareza", Buenos Aires, Argentina***
Recepción del artículo
28 de Junio, 2010 		Aprobación
30 de Agosto, 2010
Primera edición
14 de Septiembre, 2010 		Segunda edición, ampliada y corregida
7 de Junio, 2021

TUBERCULOSIS EXTENSAMENTE RESISTENTE EN LA ARGENTINA. NUESTRA EXPERIENCIA

Resumen
La tuberculosis extensamente resistente a múltiples drogas (XDR-TB) (resistente a isoniacida, rifampicina, alguna fluoroquinolona y al menos una entre kanamicina, amikacina o capreomicina), ha sido descrita en la mayoría de las regiones del mundo con efectos devastadores. Por esta razón, la información sobre seguridad, tolerabilidad y eficacia acerca de drogas potencialmente útiles en su tratamiento es de extrema utilidad, no sólo para mejorar el pronóstico individual de estos pacientes sino también para controlar su diseminación. Se presentan 18 casos de localización pulmonar en pacientes sin sida. Se trataron con esquemas que incluyeron en todos los casos linezolida; en 13, moxifloxacina, y en 13, tioridazina, todos negativizaron al examen directo y cultivo del esputo. Once pacientes cumplieron criterios de curación, 6 están aún en tratamiento y 3 abandonaron. Diez pacientes presentaron efectos adversos, en sólo 1 caso debió suspenderse la tioridazina. La utilización de linezolid, moxifloxacina y tioridazina ha contribuido a la evolución satisfactoria de estos pacientes. Estos fármacos son considerados de utilidad en esta serie, pero deben ser empleados en centros especializados con experiencia en el manejo de la XDR-TB.

Palabras clave
tuberculosis, Mycobacterium tuberculosis, tuberculosis multirresistente, tuberculosis extensamente resistente, XDR-TB


Artículo completo
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Extensively drug-resistant tuberculosis in Argentina. Our experience

Abstract
Drug-resistant tuberculosis (XDR-TB), defined as the resistance to rifampin and isoniacid plus resistance to any fluoroquinolone and at least one second-line injectable drug (amikacin, kanamycin and capreomycin), has been reported in most regions of the world and poses a new threat to TB control worldwide. Thus, information on safety, tolerability and efficacy of other drugs potentially useful in the treatment of these cases is urgent to improve individual outcomes and control the spread of XDR-TB. We describe the management and treatment outcomes of 18 cases of pulmonary XDR-TB in non-AIDS patients. All patients received daily-supervised therapy with an average of 4 drugs for which their susceptibility had been documented. These schemes included linezolid in 18, moxifloxacin in 13 and thioridazine in 13. All patients became negative to sputum and culture. Eleven patients fulfilled cure criteria, 6 are still in treatment and 3 abandoned the therapy. Long term therapy was well tolerated in most patients, ten presented adverse side effects, and, for these reasons thioridazine was stopped in one patient. Linezolid, moxifloxacyn and thioridazine contributed to the satisfactory evolution of our patients. These drugs were considered useful in the reported cases and should be used in specialized centres with experience in the management of XDR-TB.

Key words
tuberculosis, Mycobacterium tuberculosis, multidrug-resistant tuberculosis, extensively drug-resistant tuberculosis, XDR-TB

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Diagnóstico por Laboratorio, Neumonología
Relacionadas: Administración Hospitalaria, Bioquímica, Epidemiología, Farmacología, Infectología, Medicina Farmacéutica, Medicina Interna



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Enviar correspondencia a:
Eduardo Abbate, Instituto de Tisioneumonología "Prof. Dr. R. Vaccareza" , 1281, Av. Vélez Sarsfield 405, Buenos Aires, Argentina
Patrocinio y reconocimiento:
Agradecimiento: Los autores expresan su agradecimiento por la inestimable colaboración al personal del laboratorio "A. Cetrángolo" del Hospital F. J. Muñiz, Instituto de Tisioneumonología "Prof. Dr .R. Vaccareza" (Jefa: Dra. Marta Ambroggi) y de Micobacterias, Instituto Nacional de Enfermedades Infecciosas "C. G. Malbrán" (Dra. Lucía Barrera, Dra. Viviana Ritacco y Dr. Norberto Simboli) cuya valiosa tarea nos permite el manejo clínico racional de la XDR-TB.
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