IZAZOVI, NAUČENE LEKCIJE I MEĐUNARODNA SARADNJA U PREVENTIVNOM LEČENJU MULTIREZISTENTNE TUBERKULOZE (DR TPT) KOD DECE U SRBIJI
DOI:
https://doi.org/10.46793/PP250225006SKljučne reči:
preventivna terapija, multirezistentna tuberkuloza, adolescenti, decaApstrakt
Forme tuberkuloze otporne na lekove i dalje predstavljaju globalnu pretnju javnom zdravlju. Tuberkuloza otporna na više lekova (Multi drug resistant – tuberculosis MDR-TB) se definiše kao tuberkuloza (TB) otporna na rifampicin i izoniazid, esencijalne lekove u borbi protiv tuberkuloze. MDR-TB i TB rezistentna na rifampicin (RR-TB) leče se lekovima protiv TB druge linije. Sprečavanje progresije infekcije tuberkuloze otporne na lekove (DR-TB) u bolest je važan stub strategije eliminacije DR-TB. Međunarodne smernice su nedavno predložile fluorokinolone za preventivnu terapiju tuberkuloze (TPT) u kontaktima sa DR-TB. Do 2019. u Srbiji se nije sprovodila preventivna terapija za kontakte sa MDR TB , jer nije bilo uključeno u nacionalne smernice za lečenje TB i praćenje kontakata. Tokom 2019. i 2022. godine, se pojavilo nekoliko dece i adolescenata kao bliski kontakt sa slučajevima MDR TB. Preventivno lečenje tuberkuloze obavljeno je u Bolnici za dečije plućne bolesti i tuberkulozu, KBC-a „Dr Dragiša Mišović” u Beogradu, kod dvoje dece uzrasta 2 i 3 godine. U skladu sa najnovijim smernicama SZO, zahvaljujući međunarodnoj saradnji i nacionalnom multidisciplinarnom ekspertskom timu, primenjena je preventivna terapija za kontakte sa MDR-TB. Tokom implementacije TPT za kontakte dece sa MDR TB pokazalo se da su naši kapaciteti za koordinaciju programa TB, saradnja međunarodnih i multidisciplinarnih stručnjaka, epidemiološko ispitivanje, praćenje kontakata tuberkuloze osetljive na standardne lekove (engl. drug-susceptible - DS) i DR TB kod dece zadovoljavajuća. Međutim, suočili smo se sa mnogo zakonskih i sistemskih izazova. Glavni izazovi su bili nedostatak pedijatrijske formulacije lekova, nedostatak indikacija za primenu levofloksacina za tuberkulozu i upotrebu u ovoj uzrasnoj grupi.
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