Van Scoy R E
Mayo Clin Proc. 1977 Nov;52(11):694-700.
Effective antituberculosis drugs have radically improved the prognosis of the patient with active tuberculosis. Surgical therapy is rarely needed, and sanatoria have largely vanished. Initially, triple-drug therapy is indicated in cavitary pulmonary disease and severe renal disease and it is generally used in miliary tuberculosis and meningitis. Use of one of the three drugs may be discontinued after there is evidence that the bacillary population has been decreased. Two-drug therapy is indicated for other active disease. Isoniazid alone is adequate for prophylaxis. The major cause of therapeutic failure is failure of the patient to take the antituberculosis medication regularly. The second major cause of treatment failure is resistance of tubercle bacilli to the antimicrobials used. When treatment failure is apparent, careful reassessment by experienced physicians is indicated. A single drug should never be added to a failing regimen.
有效的抗结核药物已从根本上改善了活动性结核病患者的预后。很少需要手术治疗，疗养院也基本消失了。最初，三联疗法适用于空洞性肺病和严重肾病，通常用于粟粒性结核病和脑膜炎。在有证据表明细菌数量减少后，三种药物中的一种可停药。二联疗法适用于其他活动性疾病。单独使用异烟肼即可进行预防。治疗失败的主要原因是患者未规律服用抗结核药物。治疗失败的第二个主要原因是结核杆菌对所用抗菌药物产生耐药性。当明显出现治疗失败时，应由经验丰富的医生进行仔细重新评估。绝不应在失败的治疗方案中添加单一药物。
