肺結核の短期化学療法
第56回総会特別講演
1981 年 56 巻 9 号 p. 445-456
詳細
1981 年 56 巻 9 号 p. 445-456
I. Studies on Short-Course Chemotherapy at the Habikino Hospital
1. First study-Twelve month short-course chemotherapy.
Newly diagnosed bacillary pulmonary tuberculosis cases were treated by a regimen of 2-3SHR/4-3S2HR/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/16-15S2HP for 18 months a bacteriological relapse was seen in 3 cases.
2. Second study-Six to nine month short-course chemotherapy.
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.
3. Third study-Six months treatment in smear and culture negative cases.
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.
4. Fourth study-Short term chemotherapy containing PZA.
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.
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+)
II. Methods of Short-course Chemotherapy
The results of short-course chemotherapy reported by foreign and Japanese investigators were summarized, and the appropriate regimens and duration of therapy were discussed.
Personal opinion on the regimen and duration of short-course chemotherapy is summarized as follows:
1) In primary treatment by short-course chemotherapy, the regimens 3SHR/ S2HR, 3SHR/ HR or EHR are most suitable.
2) To intensify the primary treatment, PZA may be added to the above regimens for the initial two months.
3) The duration of therapy should be from 6 to 9 months for bacillary cases and 6 months for smear and culture negative cases.
