ISSN:0009-3157    

DOI:10.1159/000239505

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Tuberculosis (TB) is the leading cause of death attributable to a single infectious pathogen with one-third of the world population infected. In the USA, TB rates have fallen 3 years in succession after a sustained rise since 1985. More important are the multidrug-resistant tuberculosis (MDR-TB) cases, which are thought to be largely due to the breakdown in the delivery of health care in the USA in conjunction with HIV infection. In countries facing the HIV epidemic, the overlap of these two populations leads to a rapid acceleration of active TB and the emergence of MDR-TB. In the USA the most recent published survey (1991) revealed that 3.5% of strains were resistant to isoniazid and rifampin. Worldwide, MDR-TB is also thought to be highly prevalent, not only because of a breakdown in health infrastructure but also because of inappropriate prescription, lack of drug availability and the use of combination capsules in which the drugs are not bioavailable. Key points in therapy are to order susceptibility tests, obtain a complete drug history, treat with an adequate number of effective drugs and never, ever add a single drug to a failing regimen.

ISSN:0009-3157    

DOI:10.1159/000239506

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

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.

ISSN:0009-3157    

DOI:10.1159/000239508

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

During the past decade the number and gravity of tuberculosis (TB) cases has continued to increase, both in developing and industrialized nations. Coupled with the recent emergence of multidrug-resistant tuberculosis (MDR-TB), the possibility that untreatable forms of the disease may become widespread has arisen. In China, the prevalence rate of smear-positive cases from three national surveys in 1979, 1984-1985 and 1990 was 187, 156 and 134/100,000, respectively, thus giving an annual average reduction rate of only 3.0%. This may be due to the accumulation of chronic cases, which is not surprising given that as many as 84.3% of new smear-positive cases received non-organized chemotherapy. To counteract this situation, a strategy was developed in Beijing to practice fully supervised chemotherapy for all new smear-positive cases. This is now 90% with a cure rate also of 90%. As a result, the prevalence rate of smear-positive cases has dropped, with an average annual reduction of 17%. Building upon this success, the World Bank Loan TB Control Project in China has been carried out in 12 provinces with 550 million people since 1992. The main objective of this project is to provide fully supervised, 6-month short-course chemotherapy for all newly detected smear-positive cases. The cure rate based on cohort analysis was 88% in 1993. Complete data are not available on resistance although the initial and acquired resistance rates were 28.1 and 41.1%, respectively. MDR-TB treated with ofloxacin has been increasing since 1992, with 317 cases reported during the period 1992-1995, of which 77% showed sputum conversion.

ISSN:0009-3157    

DOI:10.1159/000239509

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Eighty-seven patients with multidrug-resistant tuberculosis (MDR-TB) diagnosed between 1988 and 1990 were treated with isoniazid and at least three other effective second-line drugs based on in vitro susceptibility tests. Of these patients, 10% failed to adhere to the regimen and 43% remained sputum positive after 6 months of treatment. Only 47% showed sputum conversion within 6 months of treatment and 12% of them relapsed during the first year of follow-up. From September 1987 to July 1989, 36 patients with MDR-TB were treated with a regimen containing rifabutin, isoniazid and at least three other susceptible drugs. Only 47% achieved a sustained sputum conversion. Four died during treatment due to disease progression. From March 1992 to July 1993, 17 cases of MDR-TB were treated with an ofloxacin-containing anti-TB regimen for 12-24 months. Two failed to adhere to the regimen for more than 1 month during the first 6 months of therapy. Among the remaining 15, 26% failed to achieve sputum conversion, 73% achieved bacterial conversion, 9 within 1 month and the other 2 within 2 months. No significant adverse effect was associated with ofloxacin use. We concluded that ofloxacin is a better choice among the more toxic and less potent second-line drugs, and should be used along with other anti-TB drugs in treating patients with MDR-TB.

ISSN:0009-3157    

DOI:10.1159/000239510

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

There is growing concern, even among developed countries, about the increasing incidence of multidrug-resistant tuberculosis (MDR-TB). Results are reported from a study investigating ofloxacin used in the treatment of 57 patients with MDR-TB. Patients received ofloxacin 400 mg/day as well as three other sensitive anti-TB drugs based on susceptibility tests. Treatment duration was 9 months. Preliminary results of 35 evaluable patients show 55% of MDR-TB cases converted to smear and culture negative within 3 months of therapy. Ofloxacin in combination with other sensitive anti-TB medication shows promise in the treatment of MDR-TB and further studies are recommended.

ISSN:0009-3157    

DOI:10.1159/000239511

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0009-3157    

DOI:10.1159/000239512

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0009-3157    

DOI:10.1159/000239513

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0009-3157    

DOI:10.1159/000239514

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The in vitro and in vivo antibacterial activities of clarithromycin (CAM), a new oral macrolide antibiotic, were compared with those of erythromycin (EM), josamycin (JM) and rokitamycin (RKM). The antibacterial spectrum and in vitro activities of CAM were similar to those of EM. Therapeutic efficacies of CAM against various experimental infections in mice – including systemic infections caused by gram-positive bacteria such as Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae, and subcutaneous abscess due to S. aureus, and bacterial pneumonia caused by S. pneumoniae – were superior to those of EM, JM and RKM. CAM exhibited higher serum levels than EM in mice after a single oral dose of 50mg

ISSN:0009-3157    

DOI:10.1159/000239437

出版商:S. Karger AG    

年代:1996

数据来源: Karger