INH・RFP併用は常に殺菌的であるか? についての日常臨床的な考察

国療化研第20次B研究

抄録

The practical value of a chemotherapy regimen must be assessed based on the observation in the programme condition. The present study on relapse consists of two kinds of survey. A: Prospective study on all converted patients initially treated with regimens containing INH, RFP or INH and RFP since 1975. B: Retrospective study on all relapsed cases after INH and/or RFP treatment. Both studies are concerned with long term chemotherapy in which drugs were continuously administered to the patients even after sputum negative conversion
A: Among 330 cases (INH alone 146, RFP alone 37 and INH-RFP 147) 5 relapsed. Relapse rate of long term initial treatment with INH-RFP was 1.0%, and that of retreatment with INH-RFP was 3.9%.
B: Among 42 relapsed cases collected, 6 were retreatment cases with INH and RFP, most of them being far advanced in X-ray picture and/or discharging a large amount of bacilli.
Although the number of cases assessed is too small to draw any definite conclusion, it is noteworthy that bacteriological relapse sometimes with bacilli resistant to the used drugs was observed during or after long term chemotherapy even with INH-RFP in the routine practice but irregular chemotherapy seems to be a cause of relapse in some cases.
The observation revealed that in the case of INH-RFP treatment, bacteriological check up should be carried out, with less regard for X-ray findings. The relapse may occur even in cases with moderately advanced non-cavitary disease, depending on the reduction in inborn or aquired resistance of the host. Therefore therapy should always be individualized.