再治療肺結核におけるRifampicin毎日と間欠療法の臨床効果の比較

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This study was undertaken in an attempt to compare the clinical results and side effectsof daily and twice weekly intermittent administration of rifampicin (RFP) in re-treatment of pulmonary tuberculosis.<BR>The subjects were 203 re-treatment cases of pulmonary tuberculosis with cavity resistantto multiple drugs who had not received RFP and pyrazynamide (PZA). They were dividedinto three groups; the first group consisting of 67 cases was given RFP 450mg daily incombination with PZA, the second group consisting of 67 cases, RFP 450mg twice weekly incombination with PZA, and the third group consisting of 69 cases, RFP 900mg twice weeklyin combination with PZA, and the treatment was continued for six months in all the groups.RFP was given orally in a single dose 30 minutes before breakfast and PZA orally in adaily dose of 1.5g divided into three doses after each meal.<BR>The background factors in these three groups are shown in Table 1. There was nodistinct difference between groups.As shown in Table 2, negative conversion rate reached to a peak at the second month oftreatment in each group and negative conversion rate by culture at the sixth month was 63per cent in the group given RFP 450mg daily and 65 per cent in the group given RFP 900mg twice weekly, while in the group given RFP 450mg twice weekly it was as low as 47 per Changes of the basic lesions in the chest X-ray films are shown in Table 3. The rate ofimprovement including slight ones at the sixth month of treatment was 20 per cent in thegroup given RFP 450 mg daily, and it was slightly higher than 13 per cent in the group given RFP 450 mg twice weekly and 10 per cent in the group given RFP 900 mg twice weekly. Asshown in Table 4, the rate of improvement of slerotic-walled cavity was low in all thegroups.For sensitivity tests against RFP, Kirchner semisolid agar medium was used, and it wasregarded as resistant when the bacilli showed resistance to more than 5 mcg/ml of RFP. Asshown in Table 5, emergence of RFP resistant tubercle bacilli was frequently observed afterfour months of treatment, when RFP administration did not succeed in negative conversion ofbacilli, and at the sixth month it was over 60 per cent in all the groups.<BR>Side effects due to RFP are shown in Table 6. Of 67 cases in the group given RFP 450mgdaily, RFP was discontinued in one case due to gastrointestinal disturbances, while there wasno case in which RFP was discontinued due to allergy-like symptoms. On the other hand, of67 cases in the group given RFP 450mg twice weekly, fever which was likely an allergicsymptom was observed in 6 cases, and among them 5 had to discontinue treatment. In addition, the treatment was discontinued in one case due to purpuric subcutaneous hemorrhage.Of 69 cases in the group given RFP 900 mg twice weekly, fever was observed in 7 cases, and 6 had to discontinue RFP. It is worth while to note that there was practically no caseshowing fever which was likely an allergic symptom in the group given RFP daily, while itwas frequently observed in groups given RFP intermittently.
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