Kekkaku. 1991 Oct;66(10):687-706.
Two issues are to be taken into consideration when we deal with the management of refractory tuberculosis in which bacilli are resistant to both INH and RFP, two major drugs in tuberculosis chemotherapy. One is how to treat such refractory TB cases and another issue is how to prevent the spread of such drug-resistant bacilli into the environment of the patients. In this symposium, therefore, they discussed on either of these two points. On the first issue of the problem, how to treat the refractory TB, Dr. Ikeda reported that chronic, bacilli-positive cases with long duration of chemotherapy showed poor prognosis, often fatal because they were usually resistant to other drugs, too, in addition to INH and RFP, whereas some cases in which no prior chemotherapy was conducted responded to ordinary regimen including INH and RFP. Dr. Ikeda recommended the use of ofloxacin for the treatment of INH and RFP--resistant TB. Ofloxacin, according to his study, was effective and kept bacilli free for more than 6 months in 15.7% of refractory cases. Dr. Masuda analyzed the factors which were responsible for the failure of treatment in INH and RFP-resistant cases. Most of the treatment failure cases, he observed, belonged to the severe cases, of which the chest x-graph revealed deviation of trachea, thickened pleural wall and multiple cavities composed of cirrhotic walls. His conclusion was that, as soon as both INH and RFP was shown ineffective, the regimen should be throughly changed with other drugs. Surgical treatment should also be taken into consideration. On the second issue of the problem, that is, how to prevent the spread of drug-resistant bacilli, Dr. Ikari described on his study of family investigation conducted in Aichi Prefecture. According to his report, the frequency of INH and RFP-resistant TB cases were not so high. However, treatment of drug-resistant cases at home sometimes led to the development of new TB cases among the family, that is infection in children and grandchildren whose bacilli were also found resistant to INH and RFP. He insisted the necessity of treatment of such cases isolated in hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
在处理耐多药结核病（即结核杆菌对结核病化疗的两种主要药物异烟肼和利福平均耐药）的管理时，有两个问题需要考虑。一个是如何治疗此类耐多药结核病病例，另一个问题是如何防止此类耐药菌传播到患者的环境中。因此，在本次研讨会上，他们讨论了这两个问题中的任何一个。关于第一个问题，即如何治疗耐多药结核病，池田医生报告说，化疗时间长的慢性痰菌阳性病例预后较差，往往致命，因为除了异烟肼和利福平外，它们通常还对其他药物耐药，而一些未进行过先前化疗的病例对包括异烟肼和利福平在内的常规方案有反应。池田医生推荐使用氧氟沙星治疗耐异烟肼和利福平的结核病。根据他的研究，氧氟沙星有效，在15.7%的耐多药病例中可使细菌清除超过6个月。增田医生分析了耐异烟肼和利福平病例治疗失败的相关因素。他观察到，大多数治疗失败病例属于重症病例，其胸部X光片显示气管偏移、胸膜壁增厚以及由硬化壁组成的多个空洞。他的结论是，一旦显示异烟肼和利福平均无效，就应彻底更换为其他药物方案。还应考虑手术治疗。关于第二个问题，即如何防止耐药菌传播，伊卡里医生描述了他在爱知县进行的家庭调查研究。根据他的报告，耐异烟肼和利福平的结核病病例发生率并不高。然而，在家中治疗耐药病例有时会导致家庭中出现新的结核病病例，即儿童和孙辈感染，其细菌也被发现对异烟肼和利福平耐药。他坚持认为有必要将此类病例隔离在医院进行治疗。（摘要截断于250字）
