既治療肺結核症におけるRFP治療の効果 : 特に薬剤耐性との関係について

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The status on admission and therapeutic effects of chemotherapy were observed in 167 pulmonary tuberculosis patients with positive culture and history of antituberculosis chemotherapy, who were hospitalized during January 1976 through December 1979 and stayed for more than 4 months at our hospital. The results were summarized as follows:<BR>1) Status on admission; 74% were male, their age distribution was 46% in the age-group 410 years and 30% in 61 years or more. On radiographic assessment, 76% of the patients had cavitation with sclerotic wall. Sensitivity revealed that 58% showed drug-resistant bacilli to more than 1 drug and 20% to 3 drugs or more of SM, INH, EB, KM and RFP.<BR>2) All patients received chemotherapy and 140 of them treated with RFP for 4 months or more. Fifteen patients died in the hospital and 138 patients were discharged, 52% within 6 months and 90% within 12 months. At the time of discharge 15 (10%) patients had positive-culture and 89 (64 patients had cavitation.<BR>3) Bacteriologic progress during chemotherapy with RFP; 105 patients were treated with RFP. INH and either one of SM, KM or EB. Among them, 70 patients were sensitive to all drugs before treatment, and 68 (97%) had favorable response; and out of 15 patients with starins resistant to SM (KM or EB), only one showed an unfavorable response, but out of 20 patients with INH-resistant strains, negative conversion was obtained in 13 (65%) patients.<BR>4) Bacteriologic relapse; Bacteriologic relapse of 114 patients showing a favorable bacteriologic response during treatment with RFP as observed from 6 to 36 months after negative conversion, and only 2 patients relapsed within 12 months.<BR>5) Emergency of drug-resistance; out of 12 patients sensitive to RFP and remained positiveculture during treatment with RFP, RFP-resistant strains appeared in 10 patients within 6 months and the rate of emergence of resistance to combined drugs was also very high.<BR>It is concluded that regimens containing RFP was highly effective for retreatment cases with drug-sensitive strains, despite the severity of the disease; and as the significance of resistance to combined drugs, resistance to INH was especially important.
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