Van Scoy R E, Wilkowske C J
Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1992 Feb;67(2):179-87. doi: 10.1016/s0025-6196(12)61320-2.
Antituberculous agents have radically improved the prognosis of patients with active tuberculosis. Generally, 6-month and 9-month antituberculous regimens have been successful, and surgical therapy is rarely needed. Extrapulmonary tuberculosis should be managed with the same drug regimens as pulmonary tuberculosis. The major cause of therapeutic failure is poor compliance of the patient in taking the prescribed medication regularly. A second cause of failure of treatment is resistance of tubercule bacilli to antimicrobial agents used. When failure of treatment is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated. A single drug should never be added to a failing regimen. Isoniazid administered prophylactically for 6 to 12 months is effective in most cases.
抗结核药物已从根本上改善了活动性肺结核患者的预后。一般来说,6个月和9个月的抗结核治疗方案已取得成功,很少需要手术治疗。肺外结核应采用与肺结核相同的药物治疗方案。治疗失败的主要原因是患者未按规定规律服药。治疗失败的第二个原因是结核杆菌对抗菌药物产生耐药性。当治疗失败明显时,建议由有结核病治疗经验的医生进行仔细的重新评估。绝不应在失败的治疗方案中添加单一药物。在大多数情况下,预防性服用异烟肼6至12个月是有效的。