The article discusses the features of the epidemiology of tuberculosis and the organization of TB control activities in the capital-metropolis on the example of London and Moscow. In these cities there is about the same incidence of tuberculosis (about 40 per 100 thousand population) and similar problems with a significant number of migrants and persons at risk of tuberculosis. At the same time, the organization of TB control in London and Moscow differs significantly: a decentralized system based on the registration of cases
for treatment which is provided preferably on an outpatient basis, in the first capital, and centralized system with dispensary follow-up of patients and mainly hospital treatment – in the second capital. Such approaches are related primarily to different epidemiological environment of the considered cities: low incidence in the whole of Great Britain, which is 3 times lower than in London, and a high incidence in other regions of the Russian Federation, which is 1.7 times higher than in Moscow.

The results of the new approaches to the quality and the safety control of the phthisiologycal medical care in Moscow Scientific and Clinical Center for TB Control are presented. The three-level system of the internal control was established, includes The Central Medical
TB Board (with subcommittees on TB in children and adolescents, on extra-pulmonary TB, on thoracic surgery, on MDR-TB) and medical boards in districts of the city of Moscow. In 2013 г. 4133 patients were considered, more than 50% – for TB verification, 30% – for treatment regimens confirmation and about 20% – in other reasons.
The centralized management control improvement enabled the good results of the new TB patients treatment (lung destruction repair in 82,5%, sputum conversion – in 93,8%, clinical recovery – in 48,6%). However the treatment success in MDR TB patients cohort-2011 was 35,0%, at that in new cases – 55,2% and in re-treatment cases appreciably low: 41,5% in relapses and 19,9% – in other cases. So, the strengthening of the management in these patients is essential.
In 2013 260 claims were obtained, include 133 about medical care quality, 17,3% of them were allowed. By patients’ anonymous questionnaires, the satisfaction with quality of care rate is 92,0%.
Implementation of the system of interior quality and care safety control, developed on the basis of internal regulations and reporting forms, allowed to improve quality indicators of the Center activity and to increase patients’ satisfaction with the quality of medical services.

In the city of Moscow the stable trend for TB infection reservoir shortening is developed. In 1995-2013, the number of the most dangerous TB infection niduses, formed by sputum smear and/or culture-positive patients, significantly decrease (p < 0,05). As a result of multicomponent activities, the number of niduses of I and II level of epidemic hazard fall from 4332 (1998) to 2195 (2013, the decreasing rate 49,3%). Particularly remarkable the results of the last four years, when the number of the most hazardous niduses reduced by 11,7% and the proportion of the uncontrolled ones – by 6,1%.
The favorable dynamics in TB niduses sanitation in the city of Moscow is achieved by the strict observance of the rules of procedures for the each case of TB, starting with the timely case detection, effective treatment and the package approach to infectious control and
prophylaxis in TB niduses. The special attention was pay to population groups, formed the hidden (poor-controlled) TB infection reservoir. Their percentage share is about 25% and, in the stable decreasing rate, in 2025, their number may be predicted as 627 niduses. But based on the current annual decreasing rate of the poor-controlled TB niduses (0,6% in 1995-2013), that number in 19 years (at 2032) may be shortened by 76. That forecast can be realized on condition that the present integrated approach to the TB infection control activities in niduses will be continued and the good epidemiological and socioeconomic situations in the city will remain.
The success in TB niduses sanitation based on the active pressure on the epidemic and is the evidence of the feasibility of the TB infection control under condition of adherence to regulated activities, which are completely put in the practice in the Moscow city.

The duly detection of tuberculosis patients is the essential for tuberculosis spreading in population control and for the increasing of the treatment success chance. For the sufficiently reliable tuberculosis control we need the integrated prophylaxis programs in population, especially in high-risk groups. The most important are activities in social and medical groups more vulnerable to tuberculosis due to the various diseases and/or pathological conditions. The article present the pilot project, approved by Moscow Government Health Department (11.06.2014 г. № 535) and named «The further perfection of the tuberculosis patients detection in the state medical care facilities in the South-West administrative district of the city of Moscow under the conditions of the relatively favorable epidemiological situation», aimed for the improvement of the quality of the pulmonary and extra-pulmonary tuberculosis patients detection in high-risk groups.

The skin test with tuberculosis recombinant allergen (Diaskintest®) has been performed in 1100 medical students, 1060 persons contacted with TB patients, 134 TB patients and 79 patients with nontuberculous diseases. Latent TB infection occurred in 5,4% of persons who were defined as TB-infected by Mantoux test with 2 TU and 14,3% of contacts. Among the contacts with positive test with Diaskintest® one patient was identified as active TB and 31 patients – with residual TB changes. The sensitivity was 73,1% (by results in TB patients), specificity – 89,9%.

The study, based on 18 females, referred in the course of 2011 year during the puerperal period in the specialized obstetrics department of the Moscow Research and Clinical TB Control Center with suspected TB (in 17 TB was confirmed), demonstrate the delay in tuberculosis (TB) detection in patients of non-specialized maternity hospitals due to the lack of alertness to tuberculosis among obstetricians. Early TB detection in pregnant allow exclude harmful contacts of an infected mother with her newborn baby and other patients of maternity hospitals. Strict observance of all regulations for TB detection in those contacting with pregnant as well as wider referral to X-ray examination of pregnant and women in puerperal period forming high-risk group for TB, may contribute to timely diagnosing this infection.

48 patients 35-69 (51,0 ± 0,6) years old with prolonged or multiple ureteral strictures specific (n = 36) and nonspecific (n = 12) origin underwent intestino ureteroplasty. Preliminary percutaneus nephrostomy was performed in 35 cases with following glomerular filtration (GF) assessment. Shown that initial level of GF less then 10 ml/min indicates on absence of renal reserves. If GF exceeds this value functional recovery of deblocked kidney occurs. Nephrectomy or nephroureterectomy is indicated in the first case and reconstructive surgery – in the second one. Ileal loop for ureteroplasty was used in 45 cases, appendix – in 3. Only ureter was replaced in 26 (54,2%) patients, ureter and bladder – in 22 (45,8%). Unilateral ureteral replacement was done in 43 cases, bilateral – in 5. Established that such kind of surgery saves patients from external drainage of the kidney and significantly improvе the quality of life in late postoperative period. Optimal method of ureteral reconstruction is ileoureteroplasty if it’s impossible – appendicoureteroplasty.

The operating regulatory acts, prescribed the procedures of treatment regimens for TB patient creating, are reviewed. The most complicated situation occurred in cases of “off label” drugs administrations (without indication “tuberculosis” in application instruction or excessive treatment duration). Such situation is ineluctable in MDR and XDR-TB, but can’t be solved based on Russian Protocol of medical care for TB patients, especially in the lack of TB treatment standards in the current Russian conditions. Convincingly shown, that Federal law 21.11.2011 N 323-FL «The fundamental principles of the health care in the Russian Federation», determined the key role of attending physician and medical board of the health care facility in treatment administration, ensure to form the legal chemotherapy regimens including drugs with “off label” indications.

In this review you can find data about tuberculosis mycobacterium resistance mechanisms to antibiotics. The data include molecular action mechanism, main pharmacokinetic characteristics and side effects of Sparfloxacin. The question of Sparfloxacin application in MDR-TB treatment is discussed in this article.