Rifampicinによる肺結核治療の臨床的研究 : 第3報再治療肺結核に対するRFP・EB併用とVM・EB併用の治療効果比較

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The present study deals with the comparison on the effect of combined use of Rifampicin (RFP) and Ethambutol (EB) with that of Viomycin (VM) and Ethambutol (EB) in retreatment cases of cavitary pulmonary tuberculosis resistant to various drugs. The subjects were allocated at random to RFP group (51 c ases) and VM group (49 cases)by means of the envelope method, and the therapy was conducted for 6 months. RFP was administered orally in the dose of 450 mg once daily before breakfast; EB orally in the dose of 1, 000 mg to cases with body weight more than 47 kg, 875 mg to cases with b. w. between 41-46 kg and 750 mg to cases with b. w. between 34-40 kg, once daily after breakfast; 1 g of VM was injected intramuscularly twice a week. The background factors of the RFP group and the VM g roup are shown in Table 1. All cases were culture positive and showed resistance to two or more anti-tuberculous agents. Comparing the two groups, patients with a history of disease longer than five years occupied 43% and 41%, and far advanced cases 67% and 63%, in the RFP and VM groups, respectively. Thus, no significant difference was observed between both groups. As presented in Table 2, negative conversion rate on c u lture reached to 92.2% already at 3 months and 92.0% at 6 months in the RFP group, and 66.7% each at 3 and 6 months in the VM group, and the difference was significant at 1% level. The cases continued negative status both on smear a nd culture for more than 3 months at 6 months of treatment, were 40 (80%) out of 50 cases in the RFP group and 26 (62%) out of 42 in the VM group. The majority of cases were occupied by cases with fibrocaseous or far advanced-mixed type in both groups, and favorable response on X-ray findings is hardly expected. As shown in Table 3, however, moderate and slight improvement of basic lesions on chest radiogram was observed in 12.0% and 30.0%, respectively, of the RFP group at 6 months, whereas slight improvement in 28.6% of the VM group. The RFP group also showed better improvement in cavities than in the VM group as shown in Table 4. The effects on various clinical symptoms at two months are shown in Table 5. The body temperature became normal or fell down in 75%, and the erythrocyte sedimentation rate was improved in 64% of the RFP group, but no significant difference was recognized between the RFP and the VM groups. Side effects du e to medication are shown in Table 6. Though side effects were observed in 5 (9.8%) out of 51 cases of the RFP group, drug administration had to be discontinued in none. On the other hand adverse reactions were found in 9 (18.4%) out of 49 cases of the VM group, and medication was discontinued in 4 cases (8.2%), 3 due to VM and 1 due to EB. Elevation of S-GOT and S-GPT was seen in a few cases of both groups, but the elevation was transient in all cases, and it was unnecessary to discontinue the treatment. In retreatment of resistant pulmonary tuberculosis with cavity, the combined use of RFP and EB showed better therapeutic effects and less side effects than the combination of VM and EB.
日本結核病学会の論文

Rifampicinによる肺結核治療の臨床的研究 : 第3報再治療肺結核に対するRFP・EB併用とVM・EB併用の治療効果比較

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