Siemion-Szcześniak Izabela, Kuś Jan
Z I Kliniki Chorób Płuc Instytut Gruźlicy i Chorób Płuc.
Pneumonol Alergol Pol. 2005;73(1):63-70.
The key element in any tuberculosis control is the early diagnosis and prompt initiation of effective therapy. This is especially important in the smear-positive patients, who are the main source of infection in the community. A six month regimen comprising rifampin, isoniazid, pyrazinamide and ethambutol/streptomycin for the initial 2 months followed by rifampin and isoniazid for a next 4 months is the recommended standard treatment for pulmonary tuberculosis. The retrospective study was designed to investigate accuracy of treatment regimens performed in patients with culture positive pulmonary tuberculosis (CPPT). Medical records of patients with CPPT treated in Warsaw, Gdansk and Siedlce in 1995 and 2000 were reviewed. Median delay in the treatment of active tuberculosis was 16 days in 1995 and 11 days in 2000. In both study groups the most patients were given the standard treatment but in only 31.8% of cases in 1994 and 34.1% in 2000 duration of chemotherapy was in accord with current guidelines. In 60.3% of cases in 1995 and in 54.1% in 2000 the treatment was prolonged without obvious reason. This is demonstrating not satisfactory acceptance of short-course therapy by physicians. Treatment given too long increas the cost of therapy, lead to more side-effects and to poor patients compliance.
任何结核病控制的关键要素都是早期诊断并迅速开始有效的治疗。这在涂片阳性患者中尤为重要，因为他们是社区中的主要传染源。对于肺结核，推荐的标准治疗方案是采用利福平、异烟肼、吡嗪酰胺和乙胺丁醇/链霉素联合治疗6个月，最初2个月使用这四种药物，随后4个月仅使用利福平和异烟肼。这项回顾性研究旨在调查对培养阳性肺结核（CPPT）患者所采用治疗方案的准确性。回顾了1995年和2000年在华沙、格但斯克和谢德尔采接受治疗的CPPT患者的病历。1995年活动性肺结核治疗的中位延迟时间为16天，2000年为11天。在两个研究组中，大多数患者都接受了标准治疗，但在1994年只有31.8%的病例以及2000年只有34.1%的病例，化疗疗程符合当前指南。在1995年60.3%的病例以及2000年54.1%的病例中，治疗被无端延长。这表明医生对短程治疗的接受度并不令人满意。治疗时间过长会增加治疗成本，导致更多副作用，并且患者依从性差。
