Maranetra K N
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chemotherapy. 1996;42 Suppl 3:10-5; discussion 30-3. doi: 10.1159/000239508.
Tuberculosis (TB) has remained the 5th leading cause of death in Thailand for several years. There has been a slight change in the total number of TB cases notified since 1985 when the first case of HIV infection was reported. Although there is an increase in the incidence of TB in HIV-infected cases, the percentage of multidrug-resistant tuberculosis (MDR-TB) in this group is the same as in the HIV-negative group (2.7%). The percentages of total initial drug resistance, four-drug resistance and MDR-TB have increased to 22.4, 1.4 and 4.8%, respectively. Comparable figures for acquired resistance are up to 2.5-, 10- and 6-fold, respectively. The rapid diagnosis and susceptibility pattern of MDR-TB are essential for improving therapeutic outcome. At present there is no defined standard regimen for MDR-TB and clinical practice has been to select a regimen of three to four sensitive or not previously exposed anti-TB drugs. Duration of treatment for 24-30 months depends on severity, previous therapy and the number of drug resistances. Surgery is suggested for persistent positive cases with localized lesions and a good cardiopulmonary reserve. The quinolone, ofloxacin, is a promising drug for MDR-TB, achieving a sputum conversion rate of 59-79%. A prospective study showed a success rate of 67% with no adverse effects. The current Bangkok multicenter trials on ofloxacin 600 mg daily combined with pyrazinamide, p-aminosalicylate, amikacin and ethambutol are ongoing. Good organization of ambulatory TB management combined with directly observed therapy will probably help to reduce the incidence of MDR-TB.
多年来，结核病一直是泰国第五大死因。自1985年报告首例艾滋病毒感染病例以来，结核病通报病例总数略有变化。尽管艾滋病毒感染病例中的结核病发病率有所上升，但该组中的耐多药结核病（MDR-TB）百分比与艾滋病毒阴性组相同（2.7%）。初始总耐药、四联耐药和耐多药结核病的百分比分别增至22.4%、1.4%和4.8%。获得性耐药的可比数字分别高达2.5倍、10倍和6倍。耐多药结核病的快速诊断和药敏模式对于改善治疗结果至关重要。目前，耐多药结核病尚无明确的标准治疗方案，临床实践是选择三到四种敏感或以前未接触过的抗结核药物组成治疗方案。24至30个月的治疗疗程取决于病情严重程度、既往治疗情况和耐药药物数量。对于病变局限且心肺储备良好的持续阳性病例，建议进行手术治疗。喹诺酮类药物氧氟沙星是一种有前景的耐多药结核病治疗药物，痰菌转阴率为59%至79%。一项前瞻性研究显示成功率为67%，且无不良反应。目前曼谷正在进行一项多中心试验，每日服用600毫克氧氟沙星联合吡嗪酰胺、对氨基水杨酸、阿米卡星和乙胺丁醇。良好地组织门诊结核病管理并结合直接观察治疗可能有助于降低耐多药结核病的发病率。
