肺結核に対するRifampicin治療に関連して

―RFP使用例の切除肺空洞内結核菌培養成績から―

抄録

Tubercle bacilli in the resected cavities of 36 pulmonary tuberculosis cases were examined by culture on 1% Ogawa's medium and by smear with Ziehl-Neelsen's staining. These caases had been treated with the regimens containing Rifampicin 450 mg daily and had shown negative conversion of tubercle bacilli in sputum for various duration prior to surgery (Group-RFP). The results of Group-RFP were compared with those of 71 cavities which were resected after negative conversion of bacilli in sputum during the treatment with primary drugs alone (Group-A), and of 44 cavities treated with second line drugs except Rifampicin (Group-B).
According to our previous studies the culture positive rate of tubercle bacilli in cavities showed clear correlation to characteristic of cavity wall at the time of operation, duration of negative sputum before operation and whether the cases are original treatment or retreatment. The positive rate of culture from cavities was higher among cases in which the duration of negative sputum was short, and it was also higher in the thick-walled cavities than in thin-walled ones, and in retreatment cases than in original treatment ones.
In the present study, in Group-RFP, pos i t ive culture was seen in 4out of 9 cases with a negative sputum for less than two months, only one out of 13 cases with 3 to 5 months negative sputum and no positive culture was demonstrated among 14 cases showing negative sputum for more than six months, in spite of the fact that most of them were retreatment cases and had thick-walled cavities. The results in Group-RFP showed clear difference when compared with that of control group A or B (Table 4). On the other hand, smear positive rate of the cavities did not show any difference among these three groups (Table 5). Although there remains a problem whether smear positive-culture negative bacilli were really died or not, higher rate of culture negative cavities in Rifampicin treated cases could be evaluated as approaching to the target of chemotherapy, namely, sterilization of cavities and no risk of relapse in future.
It could be emphasized that Rifampicin is a very effective drug even in r etreatment cases having sclerotic thick-walled cavities when the drug was taken regularly, while resistance to Rifampicin