Abstract
In patients with bone and joint tuberculosis (T. b.) with no response to rifampicin (RFP), we performed therapeutic drug monitoring using the determination of serum RFP concentrations. However, some patients could not obtain therapeutic efficacy in spite of the sufficient therapeutic concentration of RFP in serum. It was demonstrated that, using serum RFP concentration, it was not accurate to speculate the RFP concentrations in the T. b. tissues including bone, granulation tissues, and pus: Accordingly, in order to know the RFP concentrations of the T. b. tissues, we directly measured RFP concentrations of the T. b. tissues which were obtained at surgical operations. As the results, the parallel relationship between serum RFP concentrations and the RFP concentrations of the T. b. tissues could not be obtained. This finding led us to make the appropriate guideline for the therapeutic efficacy of RFP in patients with bone and joint T. b.
We studied other method for the improvement of therapeutic efficacy of RFP in the T. b. patients. Medication guide has been done in order to improve the compliance for RFP. In our medication guide, we informed the serum RFP concentrations to the patients, and we called it feedback. The patients were encouraged by this feedback; they became cooperative during their treatment; it was useful to shorten both the treament and admission periods for the patients. It was also expected that this feedback may prevent relapse of T. b.
