探究对氨基水杨酸钠异烟肼和利福喷汀及左氧氟沙星方案在复治肺结核治疗中的疗效

目的 探讨对氨基水杨酸钠异烟肼、利福喷汀及左氧氟沙星方案在复治肺结核治疗中的疗效.方法 选取2011-2012年于我院登记的复治涂阳患者107例,将患者随机分为治疗组53例和对照组54例.治疗组采用对氨基水杨酸钠异烟肼、利福喷汀、左氧氟沙星联合吡嗪酰胺、乙胺丁醇;对照组采用异烟肼、利福平、链霉素联合吡嗪酰胺、乙胺丁醇,疗程均为8个月,强化期3个月,维持期5个月.结果 共有101例患者顺利完成治疗方案,治疗组51例,痰菌阴转率88%,对照组50例,痰菌阴转率74%.治疗组痰菌阴转率高于对照组,差异有统计学意义（P＜0.05）.治疗组病灶明显吸收率高于对照组,差异有统计学意义（P＜0.05）.结论 对氨基水杨酸钠异烟肼、利福喷汀、左氧氟沙星、吡嗪酰胺、乙胺丁醇方案治疗复治肺结核疗效甚优,值得临床推广应用.     

左氧氟沙星辅治复治肺结核的疗效观察

目的 探讨左氧氟沙星辅治疗复治肺结核的临床疗效.方法 将88例复治肺结核患者随机分为治疗组和对照组各44例.对照组强化期用异烟肼0.4g,每天1次;利福喷丁胶囊0.45g,每周2次;乙胺丁醇0.75g,每天1次;吡嗪酰胺0.5g,每天3次.3个月后停用吡嗪酰胺,其余药物继续服用,治疗6个月.治疗组在对照组治疗基础上强化期加用左氧氟沙星0.4～0.6g静脉滴注,每天1次;3个月后将左氧氟沙星改为0.4～0.6g顿服,每天1次.治疗后比较2组痰菌阴转率及病灶吸收率.结果 治疗组痰菌阴转率为95.5%高于对照组的81.8%,病灶吸收率为86.4%高于对照组的68.2%,差异均有统计学意义(P＜0.05).结论 左氧氟沙星辅治复治肺结核疗效显著,值得推广应用.     

卷曲霉素治疗复治菌阳肺结核远期效果观察

目的:了解静脉滴注型卷曲霉素对复治菌阳性肺结核患者的治疗效果.方法:选复治菌阳肺结核病例,按2:1比例随机分为试验组和对照组,采用含卷曲霉素、异烟肼、利福平、吡嗪酰胺及乙胺丁醇等药物方案(2CHRZE/6H3R3E3)分别进行治疗.结果:静滴型卷曲霉素试验组强化期末与疗程结束时其痰结核菌阴转率分别为70.5%,83.3%,卷曲霉素对照组强化期末与疗程结束时痰菌阴转率为69.6%,80.8%;4年间试验组与对照组复发率分别为4.5%,5.1%;静滴型卷曲霉素组复发率低于对照组;不良反应发生比例分别为22.3%和50.6%.结论:静脉滴注型硫酸卷曲霉素治疗复治菌阳性肺结核临床效果肯定,复发率低,避免了注射部位的硬结、疼痛,减少了患者痛苦,是较好的治疗复治菌阳性结核病的药物.     

异烟肼联合胸腺五肽治疗复治菌阳肺结核的效果分析

目的探讨异烟肼与胸腺五肽联合治疗复治菌阳肺结核的临床疗效。方法随机将2017年2月至2018年5月本院收治的120例复治菌阳肺结核患者分到观察组(n=60)和对照组(n=60),两组患者均予以链霉素、利福平、吡嗪酰胺、乙胺丁醇等常规治疗,对照组患者在常规治疗基础上加以异烟肼治疗,观察组患者在常规治疗基础上加以异烟肼与胸腺五肽联合治疗,对比分析两组患者的痰菌阴转率及临床疗效。结果观察组的痰菌阴转率、临床总有效率均明显高于对照组,均有P <0.05。结论在复治菌阳肺结核中施以异烟肼与胸腺五肽联合治疗,疗效显著,并能有效提高痰菌阴转率。     

含左氧氟沙星方案治疗老年复治涂阳结核的疗效分析

目的观察不同方案治疗老年肺结核临床效果与不良反应。方法 80例老年复治涂阳肺结核,随机分为2组。治疗组40例,含左氧氟沙星(V)方案为对氨基水杨酸异烟肼、利福平、乙胺丁醇、左氧氟沙星;对照组40例,方案为对氨基水杨酸异烟肼、利福平、乙胺丁醇、吡嗪酰胺,进行3个月强化期临床观察。结果治疗组和对照组,3个月痰菌转阴率分别为85%、62.5%,差异有统计学意义(P<0.05);总有效率分别为90%、77.5%,差异有统计学意义(P<0.05);不良反应分别为30%、90%,差异有统计学意义(P<0.05);结论含左氧氟沙星方案治疗老年肺结核与对照组强化期疗效提高,不良反应明显减少,对老年肺结核安全有效。     

静脉滴注卷曲霉素治疗肺结核临床效果观察

目的：了解卷曲霉素静脉滴注替代肌注制剂对复治痰菌阳性肺结核病人的治疗效果。方法：选复治菌阳肺结核病例,按2：1比例随机分入静滴组和肌注组,采用含卷曲霉素、异烟肼、利福平、吡嗪酰胺及乙胺丁醇等药物方案（2CHRZE/6H3R3E3）分别进行治疗。结果：卷曲霉素静滴组强化期末与满疗程结束时痰结核菌阴转率分别为70.5%,83.33%,卷曲霉素肌注组强化期末与满疗程结束时痰菌阴转率为69.6%,80.82%(P＞0.05)。不良反应发生率分别为21.8%和47.1%,有显著性差异（P＜0.01）。结论：硫酸卷曲霉素静脉滴注治疗复治菌阳肺结核效果不低于肌肉注射,降低了不良反应。     

左氧氟沙星辅治复治肺结核的疗效观察

目的探讨左氧氟沙星辅治疗复治肺结核的临床疗效。方法将88例复治肺结核患者随机分为治疗组和对照组各44例。对照组强化期用异烟肼0．4g,每天1次;利福喷丁胶囊0．45g,每周2次;乙胺丁醇0．75g,每天1次;吡嗪酰胺0．5g,每天3次。3个月后停用吡嗪酰胺,其余药物继续服用,治疗6个月。治疗组在对照组治疗基础上强化期加用左氧氟沙星0．4～0．6g静脉滴注,每天1次;3个月后将左氧氟沙星改为0．4～0．6g顿服,每天1次。治疗后比较2组痰菌阴转率及病灶吸收率。结果治疗组痰菌阴转率为95．5％高于对照组的81．8％,病灶吸收率为86．4％高于对照组的68．2％,差异均有统计学意义（P〈0．05）。结论左氧氟沙星辅治复治肺结核疗效显著,值得推广应用。     

含左氧氟沙星方案治疗耐多药肺结核42例疗效分析

目的:分析含左氧氟沙星联合化疗方案在耐多药肺结核(MDR-TB)治疗中的疗效。方法:将84例MDR-TB患者随机分为治疗组(42例),对照组(42例);治疗组:采用左氧氟沙星联合异烟肼/对氨基水杨酸钠、利福喷汀、乙胺丁醇、吡嗪酰胺;对照组:采用硫酸链霉素、异烟肼/对氨基水杨酸钠、利福喷汀、乙胺丁醇、吡嗪酰胺,疗程均为12月。结果:治疗组42例观察6月痰菌阴转率69.05%(29/42),对照组42例观察6月痰菌阴转率40.48%;前者痰菌阴转率明显高于后者(P<0.01),并且病灶显著吸收,吸收率为57.14%,后者吸收率为28.57%,两组吸收率比较,治疗组优于对照组(P<0.01);治疗组药物不良反应发生率为26.19%(11/42),对照组为30.95%(13/42),经比较差异无统计学意义(P<0.05)。结论:含左氧氟沙星的联合化疗方案治疗MDR-TB,有助于痰菌阴转和病灶吸收,且药物不良反应低。     

阿莫西林/克拉维酸钾联合左氧氟沙星治疗耐多药肺结核临床疗效分析

目的 观察并评价阿莫西林/克拉维酸钾联合左氧氟沙星在耐多药肺结核(MDR-TB)治疗中的效果.方法 将101例复治涂阳耐多药肺结核患者随机分为治疗组52例和对照组49例;化疗方案:治疗组以阿莫西林/克拉维酸钾、左氧氟沙星为主,联合吡嗪酰胺、盐酸乙胺丁醇、对氨基水杨酸异烟肼、利福喷叮;对照组以左氧氟沙星为主,联合用药同治疗组;所有病例疗程均为12个月.结果 治疗中途因药物不良反应终止治疗5例,治疗组实际完成50例,对照组实际完成46例.至疗程结束,治疗组痰菌阴转率为78.0%,对照组痰菌阴转率为56.5%,痰菌阴转率治疗组明显高于对照组(P<0.05);治疗组病灶吸收有效率为78.0%,空洞闭合有效率为82.0%,病灶吸收有效率及空洞闭合有效率治疗组均明显高于对照组(P<0.05).结论 阿莫西林/克拉维酸钾联合左氧氟沙星方案治疗耐多药肺结核有助于痰菌阴转和病变吸收好转,药品不良反应低,值得在临床上推广应用.     

左氧氟沙星与吡嗪酰胺治疗老年肺结核合并 高血压患者的效果及对肾功能和不良反应的影响

目的 探讨左氧氟沙星与吡嗪酰胺治疗老年肺结核合并高血压患者的效果及对肾功能和不良反应的影响.方法 选取2017年10月～2019年10月我市定点医院收治的150例老年肺结核合并高血压患者作为研究对象.按照随机数字表法分为对照组(75例)与研究组(75例).对照组采用左氧氟沙星、利福平、乙胺丁醇、异烟肼等药物联合治疗,研...     

头孢他啶致精神异常

1例52岁女性患者,因肺结核合并结核性胸膜炎,给予左氧氟沙星、利福霉素钠、异烟肼、乙胺丁醇及吡嗪酰胺联合治疗。治疗第13天痰培养报告:阴沟肠杆菌阳性。遂加用头孢他啶2 g溶于0.9%氯化钠注射液100 ml,1次/d静脉滴注。4 d后患者出现意识模糊,胡言乱语,停用左氧氟沙星,精神症状无好转;停用头孢他啶,继续使用其他药物,精神症状消失,未再应用头孢他啶,上述症状未再出现。再次给予患者左氧氟沙星,未出现精神症状。     

纤支镜气管内注入异烟肼联合利福平治疗支气管结核临床观察

目的 探讨经纤维支气管镜(简称纤支镜)气管内局部注入异烟肼联合利福平治疗支气管结核的临床疗效及其影像学的改善情况。方法 选取医院2015年6月至2018年6月收治的支气管结核患者152例,按双色球法分为对照组和试验组,各76例。两组患者前2个月均予H3R3Z3E3方案[即每周给予异烟肼(H)、利福平(R)、吡嗪酰胺(Z)、乙胺丁醇(E)3次]治疗,后4个月均以H3R3方案治疗;试验组患者加行经纤支镜气管内局部注入异烟肼联合利福平治疗,每周1次,共6周。结果 试验组总有效率为98.68%,显著高于对照组的86.84%(P<0.05);试验组患者治疗结束1,3,6个月后痰菌阴转率分别为67.11%,81.58%,98.68%,显著高于对照组的34.21%,44.74%,71.05%(P<0.05);试验组患者治疗6个月后的病灶吸收率为98.68%,明显高于对照组的71.05%,肺不张发生率为1.32%,显著低于对照组的11.84%(P<0.05);试验组患者治疗后的血清腺苷脱氨酶(ADA)和乳酸脱氢酶(LDH)水平均显著低于对照组(P<0.05),试验组与对照组不良反应发生率相当(18.42%比19.74%,χ^2=0.043,P=0.837>0.05)。结论 经纤支镜气管内局部注入异烟肼联合利福平治疗支气管结核,可明显提高痰菌阴转率、病灶吸收率,降低肺不张发生率和血清中特异性指标水平。     

Drug treatment of tuberculosis--1992.

The impact of the acquired immunodeficiency syndrome (AIDS) pandemic has made tuberculosis an increasing worldwide problem, and the effectiveness of modern chemotherapy has been blunted by the high incidence of primary drug resistance, especially in developing countries. The prospect of finding new and highly effective drugs similar to isoniazid or rifampicin is dim, yet the maximum benefits from the existing drugs which are highly effective have not been received. A 6-month regimen of isoniazid plus rifampicin, supplemented by pyrazinamide during the first 2 months, for treatment of uncomplicated tuberculosis is highly effective and the regimen of choice. Ethambutol should be added if the risk of isoniazid resistance is increased. A regimen of isoniazid, rifampicin, pyrazinamide and streptomycin for 4 months provides effective defence against smear-negative pulmonary tuberculosis. Re-treatment of multiple drug-resistant tuberculosis remains a difficult therapeutic problem. At least 3 drugs that the patient has never previously received, and that are effective according to laboratory susceptibility testing, must be used. Preventive therapy against tuberculosis is accomplished with isoniazid for 6 to 12 months, although rifampicin plus isoniazid for 3 months has been used in the United Kingdom with success. In a mouse model, rifampicin plus pyrazinamide for 2 months is more effective than isoniazid for 6 months as preventive treatment. Patient noncompliance with medication remains the biggest problem in tuberculosis control, and is a complex issue. It can only be resolved by multiple approaches. Intermittent directly observed short course chemotherapy is a major, but not the only, possible solution.     

Effects of two pulmonary tuberculosis drug treatments and acetylator status on liver function in a Zimbabwean population

In Zimbabwe patients with pulmonary tuberculosis who are acid-fast bacilli (AFB) negative in the sputum are treated in the two month intensive phase with isoniazid, thiacetazone pyrazinamide and streptomycin (regimen A). Sputum positive patients receive regimen A plus rifampicin (regimen B). Both groups continue treatment with isoniazid and thiacetazone. 21 patients on regimen A and 19 on regimen B had clinical assessment and liver function tests performed at weeks 0, 2, 4, 8, and 12 weeks of treatment (during and four weeks after, the intensive phase of 8 weeks). Acetylator status was also assessed, no significant difference was found between patients on regimen A or B (41 per cent and 45 per cent fast acetylators respectively). Liver function tests results (alanine aminotransferase and alkaline phosphatase) showed a persisting rise during the intensive phase on both regimens, and further rise after four weeks in the continuation phase, this further rise reaching statistical significance in regimen B. These results are unexpected when compared to other studies but the regimens under investigation are not used elsewhere. The significant rise after stopping intensive therapy in regimen B suggests some protective effect of rifampicin against the hepatotoxicity of the regimen, possibly the isoniazid/thiacetazone component. Acetylator status did not influence the degree of hepatotoxicity.     

Overview of anti-tuberculosis (TB) drugs and their resistance mechanisms

One-third of the world's population is infected with Mycobacterium (M.) tuberculosis. Tuberculosis continues to be the most common infectious cause of death and still has a serious impact, medically, socially and financially. Multidrug-resistant tuberculosis (MDR-TB), caused by tubercle bacilli that are resistant to at least isoniazid and rifampin, is among the most worrisome elements of the pandemic of antibiotic resistance because TB patients for whom treatment has failed have a high risk of death. Drugs used to treat tuberculosis are classified into first-line and second-line agents. First-line essential anti-tuberculosis agents are the most effective, and are a necessary component of any short-course therapeutic regimen. The drugs in this category are isoniazid, rifampin, ethambutol, pyrazinamide and streptomycin. Second-line anti-tuberculosis drugs are clinically much less effective than first-line agents and elicit severe reactions much more frequently. These drugs include para-aminosalicylic acid (PAS), ethionamide, cycloserine, amikacin and capreomycin. New drugs, which are yet to be assigned to the above categories, include rifapentine, levofloxacin, gatifloxacin and moxifloxacin. Recently there has been much development in the molecular pharmacology of anti-tuberculosis drugs. This review summarizes information for isoniazid, rifampicin, ethambutol, pyrazinamide, and fluoroquinolones, and describes their resistance mechanisms.     

含莫西沙星强化期抗结核方案用于初治肺结核的效果评价

目的探讨强化期含莫西沙星用于初治肺结核的有效性和安全性。方法对88例初治肺结核进行了同期对照配对研究（每组44例）。其中治疗组为含莫西沙星（异烟肼、利福平、莫西沙星）的抗结核方案,对照组为异烟肼、利福平、吡嗪酰胺的治疗方案。结果抗结核治疗2个月,治疗组与对照组痰菌阴转率（95．0％与94．4％）、病灶吸收好转率（77．3％与79．5％）差异均无统计学意义（均P〉0．05））;肝损率治疗组34．1％,对照组68．2％,差异有统计学意义（P〈0．05）。结论含莫西沙星的强化期联合抗结核方案用于初治肺结核的治疗安全有效。     

Influence of rifampicin and isoniazid on the kinetics of phenytoin.

Clearance of phenytoin after i.v. injection of 100 mg was studied in six patients before and after 2 weeks daily treatment with 450 mg rifampicin, and in 14 patients with tuberculosis receiving standard treatment with 450 mg rifampicin, 300 mg isoniazid, and 1200 mg ethambutol daily. Acetylator status was measured by urinary acetylated sulphadimidine. Clearance of phenytoin in patients receiving only rifampicin increased from 46.7 ml min-1 +/- 20.6 ml min-1 to 97.8 ml min-1 +/- 33.4 ml min-1 (P less than 0.01), while clearance in patients on three drugs increased from 47.1 +/- 23.4 ml min-1 to 81.3 ml min-1 +/- 41.6 ml min-1 (P less than 0.01). No significant differences were observed between the six fast acetylators and the eight slow acetylators. Phenytoin kinetics were unchanged after further 3 months of combined treatment. Rifampicin is a strong inducer of the elimination of phenytoin. Combined treatment with isoniazid has no counter-acting effect in either fast or slow acetylators.     

Fixed dose combination short course chemotherapy in the treatment of pulmonary tuberculosis.

In this study two highly effective chemotherapeutic regimens of 6 and 8 months duration were studied and compared with the standard 12 month therapy under full supervision at the National TB Centre and St. Peter's TB Hospital in Addis Abeba. Patients with direct smear positive pulmonary tuberculosis were admitted to hospital during the initial phase of treatment for two months. At two months, sputum conversion rates, by direct smear and culture respectively, were 82% and 80% on Rifater, and 86 or 88% and 86% on the regimens containing separate preparations of isoniazid rifampicin and pyrazinamide, compared to 60% and 30% on the standard regimen. It was concluded that short course regimens of six or eight months with drugs either in combined form or separate preparations are more effective than the standard regimen.