Research progress of improving treatment of MDR-TB by identifying pyrazinamide susceptibility

doi:10.3969/j.issn.2095-3755.2014.02.001

Abstract

Abstract: Pyrazinamide (PZA) is an important component of the short course chemotherapy scheme for tuberculosis, also essential in the treatment of multidrug-resistant tuberculosis (MDR-TB). PZA affects transmembrane proton concentration gradient of Mycobacterium tuberculosis (Mtb) cell membrane and energy metabolism to kill Mtb in acid environment by its active form, pyrazinoic acid (POA). The mutations of pncA and rpsA genes are the main mechanism of PZA resistance to M.tb. MDR-TB patients have a high prevalence of PZA resistance (10%-85%), resistance to PZA in MDR-TB is associated with poor outcome, while PZA-sensitive patients using fluoroquinolone (FQ) and second-line injectable drugs (SLIDs) will significantly improve the success rate of treatment in MDR-TB. The following measures may potentially improve the curative effect, save the cost, and reduce the side effects of MDR-TB treatment: use molecular tests to rapidly identify PZA-sensitive MDR-TB (Z^S-MDR-TB), PZA-resistant MDR-TB (Z^R-MDR-TB) and susceptibility profile for FQ and SLIDs; avoid the use of PZA in the patient with Z^R-MDR-TB; and explore a combined chemotherapy regimen comprising PZA to shorten the treatment duration of Z^S-MDR-TB.

LIU Wei,SUN Feng,ZHANG Wen-hong,ZHANG Ying.. Research progress of improving treatment of MDR-TB by identifying pyrazinamide susceptibility[J]. Journal of Tuberculosis and Lung Health , 2014, 3(2): 77-81. doi: 10.3969/j.issn.2095-3755.2014.02.001

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