結核菌の薬剤耐性 : 臨床面を加味して

概要

論文の詳細を見る
Among various problems in relation to the drug resistance of tubercle bacilli, four topics which have a close connection with clinics were discussed. These are summarized as follows. I) Primary drug resistance in Japan. According to the investigation conducted by the Tuberculosis Research Committee (Ryoken) during the year 1972, 14.6 per cent of newly detected previously untreated patients with pulmonary tuberculosis showed resistance to one or more of the standard drugs. The prevalence was considerably higher than that reported from those in western countries (1971-1973). If low grade resistance which is lower than that of the japanese clinical criteria but not susceptible is added, the prevalence rate rose to 34. 2 per cent. It was stated that this was a noteworthy actual status in Japan, and based on this fact, it was emphasized that original treatment for pulmonary tuberculosis should be started with regimens including RFP or EB in place of PAS. II) The cross resistance among the five antibiotics; Kanamycin (KM), Viomycin (VM), Capreomycin (CPM), Lividomycin (LVM) and Enviomycin (TUM). The sensitivities to the five antibiotics were examined with the antibiotic-resistant strains obtained from the original strain H37Rv or Schacht in vitro showing rather low resistance to each of the antibiotics. On the basis of the data examined under various conditions, a diagram of the cross resistance among the five antibiotics was drawn up. According to the experiments on the sensitivity tests to TUM or KM with the strains isolated from patients who were treated with KM or TUM, the obvious cross resistance between these two antibiotics has not been proved. In view of these facts, for patients became resistant to KM in the routine retreatment, TUM is indicated in a next phase of treatment. It might also be possible to use TUM first, and then if necessary KM. III) Antituberculous activity of PZA and combined effectiveness with other antituberculous drugs. From the results of experiments obtained both in vitro and in vivo, it was recognized that PZA had a rather weak antituberculous activity, enhanced more or less efficacy of other drugs such as RFP, INH and TH, and furthermore inhibited slightly the emergence of RFP-resistant tubercle bacilli. In view of these experimental results together with rather high incidence of side effects of the drug, it is presumed that the combined use of PZA in the chemotherapy of tuber culosis is recommended only for cases with multiple drug resistance. IV) Drug-susceptibility test; its simplification and speed up of the procedure. Drug-susceptibility tests by the direct test method, using the Kirchner semiliquid-agar medium, were presented. By this method, it is not only possible to detect mycobacterial growth from specimens faster but also to confirm the existence and grade of primary drug resistance.
日本結核病学会の論文

結核菌の薬剤耐性 : 臨床面を加味して

スポンサーリンク

概要

著者

関連論文

スポンサーリンク