【分享】WHO提出治疗TB17个标准

米*格

Standard 1.All persons with otherwise unexplained productive cough lasting two–three weeks or more should be evaluated for tuberculosis.

Standard 2.All patients (**s, adolescents, and children who are capable of producing sputum) suspected of having pulmonary tuberculosis should have at least two, and preferably three, sputum specimens obtained for microscopic examination. When possible, at least one early morning specimen should be obtained.

Standard 3. For all patients (**s, adolescents, and children) suspected of having extrapulmonary tuberculosis, appropriate specimens from the suspected sites of involvement should be obtained for microscopy and, where facilities and resources are available, for culture and histopathological examination.

Standard 4.All persons with chest radiographic findings suggestive of tuberculosis should have sputum specimens submitted for microbiological examination.

Standard 5.The diagnosis of sputum smear-negative pulmonary tuberculosis should be based on the following criteria: at least three negative sputum smears (including at least one early morning specimen); chest radiography findings consistent with tuberculosis; and lack of response to a trial of broad spectrum antimicrobial agents. (NOTE: Because the fluoroquinolones are active against M. tuberculosis complex and, thus, may cause transient improvement in persons with tuberculosis, they should be avoided.) For such patients, if facilities for culture are available, sputum cultures should be obtained. In persons with known or suspected HIV infection, the diagnostic evaluation should be expedited.

Standard 6.The diagnosis of intrathoracic (i.e., pulmonary, pleural, and mediastinal or hilar lymph node) tuberculosis in symptomatic children with negative sputum smears should be based on the finding of chest radiographic abnormalities consistent with tuberculosis and either a history of exposure to an infectious case or evidence of tuberculosis infection (positive tuberculin skin test or interferon gamma release assay). For such patients, if facilities for culture are available, sputum specimens should be obtained (by expectoration, gastric washings, or induced sputum) for culture.

Standard 7.Any practitioner treating a patient for tuberculosis is assuming an important public health responsibility. To fulfill this responsibility the practitioner must not only prescribe an appropriate regimen but, also, be capable of assessing the adherence of the patient to the regimen and addressing poor adherence when it occurs. By so doing, the provider will be able to ensure adherence to the regimen until treatment is completed.

Standard 8.All patients (including those with HIV infection) who have not been treated previously should receive an internationally accepted first-line treatment regimen using drugs of known bioavailability. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol.The preferred continuation phase consists of isoniazid and rifampicin given for four months. Isoniazid and ethambutol given for six months is an alternative continuation phase regimen that may be used when adherence cannot be assessed, but it is associated with a higher rate of failure and relapse, especially in patients with HIV infection. The doses of antituberculosis drugs used should conform to international recommendations. Fixed-dose combinations of two (isoniazid and rifampicin,three (isoniazid, rifampicin, and pyrazinamide), and four (isoniazid,rifampicin, pyrazinamide, and ethambutol) drugs are highly recommended,especially when medication ingestion is not observed.

第一个月～第二个月                         Isoniazid,rifampicin   
（initial phase）                                 pyrazinamide,  ethambutol
第三个月～第六个月                       Isoniazid , rifampicin
（continuation phase）       

Standard 9.To foster and assess adherence, a patient-centered approach to administration of drug treatment, based on the patient’s needs and mutual respect between the patient and the provider, should be developed for all patients. Supervision and support should be gender-sensitive and age-specific and should draw on the full range of recommended interventions and available support services, including patient counseling and education. A central element of the patient-centered strategy is the use of measures to assess and promote adherence to the treatment regimen and to address poor adherence when it occurs. These measures should be tailored to the individual patient’s circumstances and be mutually acceptable to the patient and the provider. Such measures may include direct observation of medication ingestion (directly observed therapy—DOT) by a treatment supporter who is acceptable and accountable to the patient and to the health system.

Standard 10.All patients should be monitored for response to therapy, best judged inpatients with pulmonary tuberculosis by follow-up sputum microscopy (two specimens) at least at the time of completion of the initial phase of treatment (two months), at five months, and at the end of treatment. Patients who have positive smears during the fifth month of treatment should be considered as treatment failures and have therapy modified appropriately. (See Standards 14 and 15.) In patients with extrapulmonary tuberculosis and in children, the response to treatment is best assessed clinically. Follow-up radiographic examinations are usually unnecessary and may be misleading.

Standard 11.A written record of all medications given, bacteriologic response, and adverse reactions should be maintained for all patients.

Standard 12.In areas with a high prevalence of HIV infection in the general population and where tuberculosis and HIV infection are likely to co-exist, HIV counseling and testing is indicated for all tuberculosis patients as part of their routine management. In areas with lower prevalence rates of HIV, HIV counseling and testing is indicated for tuberculosis patients with symptoms and/or signs of HIV-related conditions and in tuberculosis patients having a history suggestive of high risk of HIV exposure.

Standard 13.All patients with tuberculosis and HIV infection should be evaluated to determine if antiretroviral therapy is indicated during the course of treatment for tuberculosis. Appropriate arrangements for access to antiretroviral drugs should be made for patients who meet indications for treatment. Given the complexity of co-administration of antituberculosis treatment and antiretroviral therapy, consultation with a physician who is expert in this area is recommended before initiation of concurrent treatment for tuberculosis and HIV infection, regardless of which disease appeared first. However, initiation of treatment for tuberculosis should not be delayed. Patients with tuberculosis and HIV infection should also receive cotrimoxazole as prophylaxis for other infections.

Standard 14.An assessment of the likelihood of drug resistance, based on  history of prior treatment, exposure to a possible source case having drug-resistant organisms, and the community prevalence of drug resistance, should be obtained for all patients. Patients who fail treatment and chronic cases should always be assessed for possible drug resistance For patients in whom drug resistance is considered to be likely, culture and drug susceptibility testing for isoniazid, rifampicin, and ethambutol. should be performed promptly.

Standard 15.Patients with tuberculosis caused by drug-resistant (especially multipledrug resistant [MDR]) organisms should be treated with specialized regimens containing second-line antituberculosis drugs. At least four drugs which the organisms are known or presumed to be susceptible should be used, and treatment should be given for at least 18 months. Patient centered measures are required to ensure adherence. Consultation with a provider experienced in treatment of patients with MDR tuberculosis should be obtained.

Standard 16.All providers of care for patients with tuberculosis should ensure that persons (especially children under 5 years of age and persons with HIV infection)who are in close contact with patients who have infectious tuberculosis are evaluated and managed in line with international recommendations. Children under 5 years of age and persons with HIV infection who have been in contact with an infectious case should be evaluated for both latent infection with M. tuberculosis and for active tuberculosis.

Standard 17.All providers must report both new and retreatment tuberculosis cases and their treatment outcomes to local public health authorities, in conformance with applicable legal requirements and policies.

z***x

斑竹能翻译一下，出一个英汉对照斑，也能支持一下我们国家的TB防止工作。

米*格

Standard 1.All persons with otherwise unexplained productive cough lasting two–three weeks or more should be evaluated for tuberculosis.
任何人有无法解释的有痰咳嗽超过2到3星期必须要做结核检查

Standard 2.All patients (**s, adolescents, and children who are capable of producing sputum) suspected of having pulmonary tuberculosis should have at least two, and preferably three, sputum specimens obtained for microscopic examination. When possible, at least one early morning specimen should be obtained.
所以被怀疑有肺结核的人必须至少留两套,最好3套的痰液样本供显微镜检,如果可行的话至少有一套样本要在清晨留检

Standard 3. For all patients (**s, adolescents, and children) suspected of having extrapulmonary tuberculosis, appropriate specimens from the suspected sites of involvement should be obtained for microscopy and, where facilities and resources are available, for culture and histopathological examination.
所有被怀疑有肺外结核的人应取的所怀疑部位的组织样本供显微镜检,甚至是培养病菌及组织病理学检查

Standard 4.All persons with chest radiographic findings suggestive of tuberculosis should have sputum specimens submitted for microbiological examination.
所有胸部X光显示可能有肺结核的患者都应留痰液样本供微生物检查

Standard 5.The diagnosis of sputum smear-negative pulmonary tuberculosis should be based on the following criteria: at least three negative sputum smears (including at least one early morning specimen); chest radiography findings consistent with tuberculosis; and lack of response to a trial of broad spectrum antimicrobial agents. (NOTE: Because the fluoroquinolones are active against M. tuberculosis complex and, thus, may cause transient improvement in persons with tuberculosis, they should be avoided.) For such patients, if facilities for culture are available, sputum cultures should be obtained. In persons with known or suspected HIV infection, the diagnostic evaluation should be expedited.
痰液抹片阴性的肺结核诊断准则为:所有痰液抹片(包括至少一套清晨留检的痰液样本)为阴性,ˇ但胸部X光持续显示为肺结核.而且肺部病灶对广效性抗生  素治疗没有疗效.对于这样的病患应该给予痰液培养检查.怀疑或是hiv带原病患这各诊断流程要快速一点.

Standard 6.The diagnosis of intrathoracic (i.e., pulmonary, pleural, and mediastinal or hilar lymph node) tuberculosis in symptomatic children with negative sputum smears should be based on the finding of chest radiographic abnormalities consistent with tuberculosis and either a history of exposure to an infectious case or evidence of tuberculosis infection (positive tuberculin skin test or interferon gamma release assay). For such patients, if facilities for culture are available, sputum specimens should be obtained (by expectoration, gastric washings, or induced sputum) for culture.

在痰液抹片检查为阴性但有症状的小孩若要诊断为胸内结核(也就是肺内,肋膜,中膈腔或气管的淋巴结)的准则为:胸部X光持续显示为结核且与确定结核病 患有接触的病史或其它检查显示有结核感染(阳性的结核菌素皮肤测验或是阳性的干扰素gamma释放测验)对于酱子的病患如果可行的话应予以痰液样本的培养

Standard 7.Any practitioner treating a patient for tuberculosis is assuming an important public health responsibility. To fulfill this responsibility the practitioner must not only prescribe an appropriate regimen but, also, be capable of assessing the adherence of the patient to the regimen and addressing poor adherence when it occurs. By so doing, the provider will be able to ensure adherence to the regimen until treatment is completed.

所有治疗结核病患的医师应自觉担负着重要的公卫责任.为符合这项责任医师应给予正确配方之外也应完整评估治疗的持续性,特别注意病患有不遵医嘱的情形.所有医师都应该确保疗程的完整性.

Standard 8.All patients (including those with HIV infection) who have not been treated previously should receive an internationally accepted first-line treatment regimen using drugs of known bioavailability. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol.The preferred continuation phase consists of isoniazid and rifampicin given for four months. Isoniazid and ethambutol given for six months is an alternative continuation phase regimen that may be used when adherence cannot be assessed, but it is associated with a higher rate of failure and relapse, especially in patients with HIV infection. The doses of antituberculosis drugs used should conform to international recommendations. Fixed-dose combinations of two (isoniazid and rifampicin,three (isoniazid, rifampicin, and pyrazinamide), and four (isoniazid,rifampicin, pyrazinamide, and ethambutol) drugs are highly recommended,especially when medication ingestion is not observed.

所有以前没有治疗过的结核病患(包括HIV感染者)应接受国际公认的第一线用药,开始的治疗必须包含两各月的isoniazid, rifampicin, pyrazinamide, and ethambutol药物治疗.接着是四各月的isoniazid and rifampicin 药物治疗(如果病患的用药顺从性无法评估也可以给予六各月Isoniazid and ethambutol 药物治疗,但是会有较高的治疗失败或复发的机率,尤其是HIV感染者更是如此).抗结核药物的剂量应符合国际标准,固定剂量的多重药物治疗(isoniazid and rifampicin两种合并,isoniazid, rifampicin, and pyrazinamide三种合并,以及isoniazid,rifampicin, pyrazinamide, and ethambutol四种合并)是被高度建议的,尤其是当病患用药无法监测时.

第一个月～第二个月                         Isoniazid,rifampicin   
（initial phase）开始期                                 pyrazinamide,  ethambutol
第三个月～第六个月                       Isoniazid , rifampicin
（continuation phase） 后续治疗期      

Standard 9.To foster and assess adherence, a patient-centered approach to administration of drug treatment, based on the patient’s needs and mutual respect between the patient and the provider, should be developed for all patients. Supervision and support should be gender-sensitive and age-specific and should draw on the full range of recommended interventions and available support services, including patient counseling and education. A central element of the patient-centered strategy is the use of measures to assess and promote adherence to the treatment regimen and to address poor adherence when it occurs. These measures should be tailored to the individual patient’s circumstances and be mutually acceptable to the patient and the provider. Such measures may include direct observation of medication ingestion (directly observed therapy—DOT) by a treatment supporter who is acceptable and accountable to the patient and to the health system.

为促进与评估用药顺虫性需建立以病患为中心,基于病患的需要以及医病间的相互尊重的治疗方式.对于病患的监督和支持应根据性别及年龄做调整,一定要给予病患完整的治疗以及充分的社会支持,包括病人的咨询与教育,以病患为中心的治疗策略最重要的部分是评估和促进用药的顺从性,并及时察觉不遵医嘱用药的情况.
而治疗的策略应该要根据个别病患的环境,和医师间的互动来做调整,这些策略可以包括由病人信得过的人直接看着病患服用药物(DOT).
Standard 10.All patients should be monitored for response to therapy, best judged inpatients with pulmonary tuberculosis by follow-up sputum microscopy (two specimens) at least at the time of completion of the initial phase of treatment (two months), at five months, and at the end of treatment. Patients who have positive smears during the fifth month of treatment should be considered as treatment failures and have therapy modified appropriately. (See Standards 14 and 15.) In patients with extrapulmonary tuberculosis and in children, the response to treatment is best assessed clinically. Follow-up radiographic examinations are usually unnecessary and may be misleading.
所有病患都应监测治疗反应,在最初治疗时,第二各月时,第五各月时,以及结束治疗时应该做两套痰液显微镜检追踪.第五各月时痰液抹片如仍为阳性应是为治疗失败,治疗配方应重新评估(键标准14.15).在肺外结核还有儿童治疗反应应根据临床评估,胸部x光追踪通常是不必要而且是可能会误导的.

Standard 11.A written record of all medications given, bacteriologic response, and adverse reactions should be maintained for all patients.
所有病患的用药纪录,细菌学上的反应以及副作用,都应详细'记载

Standard 12.In areas with a high prevalence of HIV infection in the general population and where tuberculosis and HIV infection are likely to co-exist, HIV counseling and testing is indicated for all tuberculosis patients as part of their routine management. In areas with lower prevalence rates of HIV, HIV counseling and testing is indicated for tuberculosis patients with symptoms and/or signs of HIV-related conditions and in tuberculosis patients having a history suggestive of high risk of HIV exposure.
在HIV感染盛行区域以及结核和HIV共同感染盛行区域的结核病患,常规的HIV检查是必须的.如果是HIV低感染盛行区域,HIV检查只施行在有HIV相关症状的结核病患以及暴露于HIV的高危险病患.

Standard 13.All patients with tuberculosis and HIV infection should be evaluated to determine if antiretroviral therapy is indicated during the course of treatment for tuberculosis. Appropriate arrangements for access to antiretroviral drugs should be made for patients who meet indications for treatment. Gven the complexity of co-administration of antituberculosis treatment and antiretroviral therapy, consultation with a physician who is expert in this area is recommended before initiation of concurrent treatment for tuberculosis and HIV infection, regardless of which disease appeared first. However, initiation of treatment for tuberculosis should not be delayed. Patients with tuberculosis and HIV infection should also receive cotrimoxazole as prophylaxis for other infections.
同时感染结合及HIV的病患,必须评估是否再治疗结合的疗程中加入抗HIV病毒的治疗,如果评估后应同时做抗病毒的治疗应给予适当的配方.由于抗结核合并抗病毒治疗的复杂性,在开始做治疗时应照会对此方面有经验的专家.无论如何抗结核治疗不可以拖延,同时感染结核与HIV的病患应该接受 cotrimoxazole 药物治疗防制其它感染

Standard 14.An assessment of the likelihood of drug resistance, based on  history of prior treatment, exposure to a possible source case having drug-resistant organisms, and the community prevalence of drug resistance, should be obtained for all patients. Patients who fail treatment and chronic cases should always be assessed for possible drug resistance For patients in whom drug resistance is considered to be likely, culture and drug susceptibility testing for isoniazid, rifampicin, and ethambutol. should be performed promptly.
所有结核病患必须从以前治疗的病史及接触有抗药菌株的结核病患的病史来评估是否有抗药性的可能性.所有治疗失败以及慢性结合的病患都应评估抗药性的可能性,如果病患可能有抗药性感染应该做菌株培养以及对isoniazid, rifampicin, and ethambutol 药物的感受性测验.


Standard 15.Patients with tuberculosis caused by drug-resistant (especially multipledrug resistant [MDR]) organisms should be treated with specialized regimens containing second-line antituberculosis drugs. At least four drugs which the organisms are known or presumed to be susceptible should be used, and treatment should be given for at least 18 months. Patient centered measures are required to ensure adherence. Consultation with a provider experienced in treatment of patients with MDR tuberculosis should be obtained.
被多重抗药菌株感染的结核病患必须以包含第二线抗结核药物的特殊配方来治疗.至少四种对菌株有疗效的药物应包含在配方内,而治疗时间至少要18各月.建立以病患为中心的治疗方式,确保病患服药的持续性.必须照会对治疗抗药菌株有经验的专家.

Standard 16.All providers of care for patients with tuberculosis should ensure that persons (especially children under 5 years of age and persons with HIV infection)who are in close contact with patients who have infectious tuberculosis are evaluated and managed in line with international recommendations. Children under 5 years of age and persons with HIV infection who have been in contact with an infectious case should be evaluated for both latent infection with M. tuberculosis and for active tuberculosis.
医疗提供者都应该确定所有和结核病患有密切接触的人必须接受符合国际标准的结核评估与处理,小于五岁的儿童和HIV带原者如有接触的病史应该接受潜伏性及活动性结核评估与处理
         
Standard 17.All providers must report both new and retreatment tuberculosis cases and their treatment outcomes to local public health authorities, in conformance with applicable legal requirements and policies.
所有医疗提供者必须报告新病患及重新治疗者名单以及她们的治疗结果给地方公卫机构,以符合当地法令要求.

乐*

米*** 果然言而有信，感谢翻译。

此帖同时转到结核版块共享。

[ 本帖最后由 乐园 于 2006-10-20 16:56 编辑 ]

y****e

多谢 楼主

氨***X

感谢班主,不过有点头晕!:lol:

不****笑

你有毛病啊,直接翻译过来不好吗?

－－－－－－－－－－－－－－－－－－－－－－－－－－
请注意尊重别人的劳动，现在不是直接翻译过来的么？楼主发布的原文件，鉴于有些战友英文水平有限特别邀请楼主翻译成中文。对别人的劳动不尊重还进行指责，送鸡蛋一枚以警告。－－乐园

[ 本帖最后由 乐园 于 2006-12-4 19:13 编辑 ]

l****2

多谢楼主的贡献啊，我的英文菜菜！

文章的大部分标准因全球资金项目的启动基本上都已落实，少部分因技术力量及资金方面的不足未能开展。
总的来说，还是人才少，money（钱）少啊！国人的悲哀啊！更是我们医务工作者的悲哀！
呵呵～
顺便对上述的药物名称进行添加（也许大部分仁兄都知道，不过为了像我这样对E文完全免疫的人群，只好画蛇添足了……嘿嘿）
isoniazid——异烟肼
rifampicin——利福平
pyrazinamide——吡嗪酰胺
ethambutol——乙胺丁醇

[ 本帖最后由 leegh112 于 2006-12-6 20:10 编辑 ]

乐*

感谢leegh112战友的补充。

z****u

感谢leegh112战友