肺結核の短期化学療法 : 第56回総会特別講演
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I. Studies on Short-Course Chemotherapy at the Habikino Hospital<BR>1. First study-Twelve month short-course chemotherapy.<BR>Newly diagnosed bacillary pulmonary tuberculosis cases were treated by a regimen of 2-3SHR/4-3S<SUB>2</SUB>HR/6HP for 12 months. In all cases the cultures converted to negative by the 4th month. Of the 112 cases in whom follow-up was possible no cases with a bacteriological relapse were observed up to 4 years, whereas in the 105 control cases treated with 2-3SHP/16-15S<SUB>2</SUB>HP for 18 months a bacteriological relapse was seen in 3 cases.<BR>2. Second study-Six to nine month short-course chemotherapy.<BR>Duration of the HP administration in the first study was shortened to 0 to 3 months, accordingly the total duration of treatment was shortened to 6 to 9 months. Of the 132 cases in whom follow-up observation was performed, a bacteriological relapse was seen in only 3 cases (2%) up to four years after the termination of therapy.<BR>3. Third study-Six months treatment in smear and culture negative cases.<BR>In primary treatment of smear and culture negative cases, a 6 months treatment of 3SHR/3HR was performed. In the 115 cases observed from 3 to 24 months after the cessation of therapy, no cases showing worsening was observed.<BR>4. Fourth study-Short term chemotherapy containing PZA.<BR>To the chemotherapy regimen used in the second study, PZA 1.5 g was added for the initial 2 months. Of 70 cases treated with this SHRZ regimen cultures converted to negative by the third month in all cases. The negative conversion rate at the second month was 96% in contrast to 87% seen in the first study.<BR>This difference in the culture negative conversion rate between SHRZ and SHR regimens was more marked in cases showing abundant growth on culture (+++ or ++++) than cases showing fewer growth (++or+)<BR>II. Methods of Short-course Chemotherapy<BR>The results of short-course chemotherapy reported by foreign and Japanese investigators were summarized, and the appropriate regimens and duration of therapy were discussed.<BR>Personal opinion on the regimen and duration of short-course chemotherapy is summarized as follows:<BR>1) In primary treatment by short-course chemotherapy, the regimens 3SHR/ S2HR, 3SHR/ HR or EHR are most suitable.<BR>2) To intensify the primary treatment, PZA may be added to the above regimens for the initial two months.<BR>3) The duration of therapy should be from 6 to 9 months for bacillary cases and 6 months for smear and culture negative cases.
- 日本結核病学会の論文
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