School of Pharmacy, Sungkyunkwan University, Suwon 16419, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon 16149, South Korea.
School of Pharmacy, Sungkyunkwan University, Suwon 16419, South Korea.
J Microbiol Immunol Infect. 2022 Oct;55(5):917-925. doi: 10.1016/j.jmii.2021.11.007. Epub 2021 Nov 30.
BACKGROUND/PURPOSE(S): The World Health Organization (WHO) released treatment guidelines for multidrug resistant tuberculosis (MDR-TB) in 2008, with subsequent revisions in 2011; Korea disseminated corresponding guidelines in 2011 and 2014, respectively. Thus, we aimed to investigate the temporal trends of and the updated guideline's impact on the prescription patterns of anti-TB drugs.
We conducted a time-series study using Korea's nationwide healthcare database (2007-2015), where patients with TB or MDR-TB were included. Only anti-TB drugs prescribed during the intensive phase of treatment for TB (two months) or MDR-TB (eight months) were assessed. We estimated the annual utilization of TB treatment regimens and the relative difference (RD) in the proportion of MDR-TB treatment medications between the following periods: before the first Korean guideline (June 2008 to March 2011); between the first and revised guidelines (April 2011 to July 2014); after the revised guideline (August 2014 to December 2015).
Of 3523 TB (mean age 54.1 years; male 56.8%) patients, treatment regimens for TB complied with guideline recommendations as >80% of patients received either quadruple (mean 66.8%) or triple (14.5%) therapy of first-line anti-TB drugs. Following the WHO's guideline update, prescription patterns changed accordingly among 111 MDR-TB (mean age 46.0 years; male 67.6%) patients, as use of pyrazinamide (RD +20.3%) and prothionamide (+11.5%) increased (recommended to be compulsory), and streptomycin (-43.1%) decreased (ototoxicity risks).
Anti-TB drug prescription patterns for both TB and MDR-TB well reflected WHO's treatment guideline as well as corresponding domestic guidelines of South Korea.
背景/目的：世界卫生组织（WHO）于 2008 年发布了耐多药结核病（MDR-TB）治疗指南，随后于 2011 年进行了修订；韩国分别于 2011 年和 2014 年发布了相应的指南。因此，我们旨在研究时间趋势以及更新指南对抗结核药物处方模式的影响。
我们使用韩国全国医疗保健数据库（2007-2015 年）进行了时间序列研究，其中包括结核病或 MDR-TB 患者。仅评估了结核病强化期（两个月）或 MDR-TB 强化期（八个月）治疗期间开具的抗结核药物。我们估计了结核病治疗方案的年度利用率以及以下两个时期 MDR-TB 治疗药物比例的相对差异（RD）：第一个韩国指南之前（2008 年 6 月至 2011 年 3 月）；第一个和修订后的指南之间（2011 年 4 月至 2014 年 7 月）；修订后的指南之后（2014 年 8 月至 2015 年 12 月）。
在 3523 例结核病（平均年龄 54.1 岁；男性 56.8%）患者中，结核病的治疗方案符合指南建议，因为>80%的患者接受了四联（平均 66.8%）或三联（14.5%）一线抗结核药物治疗。在世界卫生组织指南更新后，111 例 MDR-TB（平均年龄 46.0 岁；男性 67.6%）患者的处方模式也相应发生了变化，因为吡嗪酰胺（RD+20.3%）和丙硫异烟胺（RD+11.5%）的使用增加（建议为强制性），而链霉素（RD-43.1%）的使用减少（耳毒性风险）。
结核病和 MDR-TB 的抗结核药物处方模式均很好地反映了世界卫生组织的治疗指南以及韩国相应的国内指南。
