DRESS (drug reaction with eosinophilia and systemic symptom) syndrome caused by both first-line and second-line antitubercular medications: A case report with a brief literature review

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome.

Therapies for crohn's disease: a clinical update / Terapia farmacológica em portadores de doença de Crohn. Atualização clínica

ABSTRACT The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

RESUMO Os principais objetivos da terapia clínica na doença de Crohn são a remissão clínica e endoscópica por tempo prolongado, sem o uso de corticosteroides, além de evitar hospitalizações e cirurgias, e melhorar a qualidade de vida. A principal limitação da terapêutica medicamentosa é a perda de reposta a longo prazo, o que faz com que a incorporação de novas drogas ao arsenal terapêutico seja necessária. Esta revisão aborda os principais medicamentos utilizados atualmente no tratamento clínico da doença de Crohn.

Outcomes and Use of Therapeutic Drug Monitoring in Multidrug-Resistant Tuberculosis Patients Treated in Virginia, 2009-2014 / 결핵및호흡기질환

BACKGROUND: Reports of therapeutic drug monitoring (TDM) for second-line medications to treat multidrug-resistant tuberculosis (MDR-TB) remain limited. METHODS: A retrospective cohort from the Virginia state tuberculosis (TB) registry, 2009-2014, was analyzed for TDM usage in MDR-TB. Drug concentrations, measured at time of estimated peak (Cmax), were compared to expected ranges. RESULTS: Of 10 patients with MDR-TB, 8 (80%) had TDM for at least one drug (maximum 6 drugs). Second-line drugs tested were cycloserine in seven patients (mean C2hr, 16.6+/-10.2 microg/mL; 4 [57%] below expected range); moxifloxacin in five (mean C2hr, 3.2+/-1.5 microg/mL; 1 [20%] below); capreomycin in five (mean C2hr, 21.5+/-14.0 microg/mL; 3 [60%] below); para-aminosalicylic acid in five (mean C6hr, 65.0+/-29.1 microg/mL; all within or above); linezolid in three (mean C2hr, 11.4+/-4.1 microg/mL, 1 [33%] below); amikacin in two (mean C2hr, 35.3+/-3.7 microg/mL; 1 [50%] below); ethionamide in one (C2hr, 1.49 microg/mL, within expected). Two patients died: a 38-year-old woman with human immunodeficiency virus/acquired immune deficiency syndrome and TB meningitis without TDM, and a 76-year-old man with fluoroquinolone-resistant (pre-extensively drug-resistant) pulmonary TB and low linezolid and capreomycin concentrations. CONCLUSION: Individual pharmacokinetic variability was common. A more standardized approach to TDM for MDR-TB may limit over-testing and maximize therapeutic gain.

Successful readministration of second-line antituberculous agents in a patient with near-fatal drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.

Mesalazina grânulos (2 gramas sachê ) para o tratamento de retocolite ulcerativa / Mesalazine granules (2 grams sachet) for the treatment of ulcerative colitis

A Colite ulcerativa e a Doença de Crohn são as duas formas principais de doenças inflamatórias intestinais. Apesar de algumas características em comum, elas podem ser diferenciadas por predisposições genéticas, fatores de risco e diferentes aspectos clínicos, endoscópicos e histológicos. A etiologia ainda é desconhecida, no entanto, indivíduos suscetíveis parecem apresentar resposta imunológica alterada à flora comensal na mucosa, resultando em inflamação. Na retocolite ulcerativa a inflamação é restrita à superfície mucosa, inicia-se, geralmente, no reto e estende-se a todo o cólon. O diagnóstico da colite ulcerativa é baseado nos sintomas clínicos e confirmado por achados objetivos na endoscopia e histologia. O tratamento compreende aminossalicilatos orais e por via retal, corticoides e imunossupressores. É feito de maneira a tratar a fase aguda e após, manter a remissão, sendo o maior objetivo reduzir a sintomatologia. A Tecnologia: Tipo: Medicamento; Princípio Ativo: Mesalazina; Nome comercial: Pentasa® Sachê 2g; Fabricante: Laboratório Ferring Ltda. Mesalazina 2 gramas na formulação de grânulos de liberação prolongada, na forma farmacêutica de sachê, em dose única diária para o tratamento da colite ulcerativa é uma nova apresentação do medicamento. Atualmente, o Ministério da Saúde fornece o medicamento (mesalazina em grânulos) na apresentação de 0,5g em comprimidos aos pacientes diagnosticados com Retocolite Ulcerativa na rede pública de saúde. A proponente indica que nova apresentação proporcionaria maior aderência dos pacientes resultando em maior efetividade do tratamento. Análise da evidência apresentada pelo demandante: Demandante: Ferring International Center SA. Somente serão avaliados os estudos que se enquadram nos critérios e stabelecidos na solicitação por incorporação da tecnologia (tecnologia, indicação, comparadores), submetida pelo demandante. Considerações finais: A evidência atualmente disponível sobre eficácia e segurança do mesalazina sachê 2g para tratamento da colite ulcerativa é baseada fundamentalmente no estudo de Dignass 30 (ensaio clínico multicêntrico, randomizado, de não inferioridade). O estudo comparou mesalazina em grânulos, sachê 2g dose única diária à mesma dose diária dividida em duas tomadas. Foram Incluídos 362 pacientes com colite ulcerativa em remissão. O desfecho primário foi taxa de remissão em 1 ano baseado no disease activity index score. Dentre os desfechos secundários, foi avaliada a aderência à medicação entre os grupos, medida pelo número de sachês distribuídos e retornados, questionário auto-administrado, e escala visual analógica. Recomendação da CONITEC: Considerando a falta de evidências científicas mais robustas, o fato de o estudo apresentado ser de não inferioridade com limitações, que há no SUS tratamento disponível com outra forma farmacêutica do mesmo medicamento para a indicação em questão e a magnitude limitada dos benefícios, após discussão, os membros da CONITEC, presentes na 13ª Reunião do plenário, realizada no dia 07/03/2013, deliberaram por não recomendar a incorporação do medicamento mesalazina grânulos (2 gramas sachê) para o tratamento da colite ulcerativa. Deliberação final: Após análise das contribuições da consulta pública e considerando a preocupação do plenário da CONITEC sobre o impacto orçamentário decorrente da possível migração de pacientes que consomem outras apresentações disponíveis no SUS (de 400mg e 800mg de liberação convencional, as quais se apresentam como medicamento genérico), e o fato de que poderá haver desperdício no sachê, os membros do plenário da CONITEC decidiram buscar mais informações de impacto orçamentário do medicamento, considerando doses e migração entre as formas farmacêuticas. Com isso, foram apresentadas informações compiladas pelo Departamento de Assistência Farmacêutica e Insumos Estratégicos (DAF) acerca do impacto orçamentário do uso de mesalazina por via oral (comprimidos) nos pacientes com Retocolite Ulcerativa no Componente Especializado da Assistência Farmacêutica (CEAF), em 2012. Conforme a análise, foram atendidos 26.824 pacientes. Os membros da CONITEC presentes na reunião do plenário do dia 03/07/2013 deliberaram, por unanimidade, por não recomendar a incorporação da mesalazina sachê 2g para o tratamento da retocolite ulcerativa. Portaria nº 43, de 23 de agosto de 2013 - Decisão de não incorporar o medicamento mesalazina sachê 2g para o tratamento da retocolite ulcerativa no Sistema Único de Saúde (SUS).

Extensively drug resistance (XDR) tb is not always fatal.

The chance of incidence of XDR TB is on the rise due to improper use of second line anti-tubercular drugs. XDR-TB is very difficult to treat successfully and is often referred to as "virtually untreatable form of TB". We herein report a case of XDR TB confirmed by bacteriological examination in a WHO recognised laboratory who after 12 months of regular treatment improved both clinically and radiologically with sputum smear conversion. To the best of our knowledge, there has been no previous report of any similar case in literature.

Drug resistance of Mycobacterium tuberculosis in children / 소아과

PURPOSE: The rate of drug-resistant tuberculosis (DR-TB) in children is an indicator of the effectiveness of TB control programs in the community. This study aimed to assess the prevalence of DR-TB in children and evaluate TB management. METHODS: Between January 1999 and July 2007, drug susceptibility tests for anti-TB drugs were employed for patients aged less than 19 years with culture-positive TB. RESULTS: A total of 607 cases (16.6%) were resistant to at least one anti-TB drug as follows: isoniazid (INH; 13.8%), rifampin (8.9%), pyrazinamide (4.2%), streptomycin (3.7%), ethambutol (EMB; 5.9%), and para-aminosalicylic acid (PAS; 1.9%). Multidrug-resistant (MDR) TB was found in 276 cases (7.6%); extensive drug resistant (XDR) TB, in 5 case s (0.2%). The rate of resistance to at least one anti-TB drug in children aged >15 years (16.1%) was significantly lower than that in children aged <15 years (20.5%) (P=0.016). The rate of resistance to at least one anti-TB drug and multidrug-resistance in this survey decreased significantly (P<0.001) as compared to the previous survey (1987-1995). The rate of resistance to INH, EMB, and PAS also significantly decreased (P<0.05 ). CONCLUSION: The rate of DR-TB in children in Korea has decreased over time; however, it remains higher than that in other countries. MDR-TB and XDR-TB are the emerging problems in Korean children. Therefore, the selection of effective drugs through drug susceptibility tests and evaluating risk factors of resistant TB is essential to successful therapy and a decreased incidence of DR-TB.

Outcome of multi-drug resistant tuberculosis cases treated by individualized regimens at a tertiary level clinic.

AIM: To determine the clinical, radiological and drug resistance profile as well as the factors associated with treatment outcome of Multi-Drug Resistant Tuberculosis (MDR-TB). MATERIAL AND METHODS: All newly diagnosed patients with pulmonary MDR-TB from August 2002 to December 2004 enrolled at New Delhi Tuberculosis Centre, were included in the study. They were followed up clinically, radiologically and bacteriologically by sputum smear, culture and Drug Susceptibility Testing (DST) at regular intervals. According to their DST pattern and previous history of Anti-Tubercular Treatment (ATT), individualized treatment regimens were tailored for each patient. RESULTS: Out of total 27 bacteriologically proven cases of MDR-TB included in this study, 19 were males (mean age and weight 38.5 years and 52.6 kgs, respectively) and eight females (mean age and weight 34.3 years and 40.7 kgs, respectively). A majority (18) were residents of Delhi and the rest hailed from different parts of North India. All of them had a history of previous treatment ranging from six to 34 months. Cavity on chest X-rays was seen in 81%, while 44% showed extensive involvement. The patients received at least four "second line drugs" during their treatment with a mean of 6.2 anti-tubercular drugs during their intensive phase. Of the 27 patients, 13 were cured, 10 defaulted, one died, one is still on treatment and two were referred for surgery. Radiological improvement was observed in two third of cases and chest X-ray of two patients showed a complete resolution. Six predictors were identified for successful outcome of MDR-TB. They include weight gain at six months, culture conversion, radiological improvement during treatment, disease with M. tuberculosis strains exhibiting resistance to less than or up to three anti-tubercular drugs, use of less than or up to three second line drugs in treatment and no change of regimen during treatment. CONCLUSION: Default from treatment was observed to be a major challenge in the treatment of MDR-TB due to long duration and expense of ATT.

Comparison of Anti-mycobacterial Drug Susceptibility Test Results by Institutes and Methods / 대한임상미생물학회지

BACKGROUND: The purposes of the current study were to evaluate the concordant rates of anti-mycobacterial drug susceptibility test (DST) results in different solid media performed in different institutes, and to determine reliable susceptible testing methods. METHODS: One hundred and twenty two Mycobacterium tuberculosis strains were isolated from patients in A Hospital in 2005. DSTs were performed by the absolute concentration method using L?wenstein Jensen medium in both A Hospital (method A-1) and B Institute (method B-1) and by the proportion method using Middlebrook 7H10 agar in B Institute (method B-2). Nine drugs were used including isoniazid and rifampin. Sensitivity and specificity of each method were estimated by using the acceptable standard of 90% for isoniazid and rifampin and 80% for other drugs. The therapeutic outcomes of quinolone-administered patients were evaluated according to ofloxacin susceptibility results. RESULTS: Method B-1 showed sensitivity and specificity levels over the acceptable standard levels for all drugs. Method B-2 showed specificity lower than the acceptable levels for rifampin and cycloserine. Method A-1 showed specificity lower than the acceptable levels for isoniazid, streptomycin, p-aminosalicylic acid, and ofloxacin and sensitivity lower than the acceptable levels for prothionamide and cycloserine. The concordance rates of therapeutic outcomes with method B-1, method B-2, and method A-1 were 77%, 74%, and 65%, respectively. CONCLUSION: The drug susceptibility results for some drugs were discordant between the testing laboratories and media, requiring an urgent application of quality control programs to raise the reliability of anti-mycobacterial DST.

Efficacy and safety of kanamycin, ethionamide, PAS and cycloserine in multidrug-resistant pulmonary tuberculosis patients.

BACKGROUND: We carried out this study to determine the efficacy and safety of a regimen containing kanamycin, ethionamide, isoniazid, para-aminosalicylic acid (PAS) and cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB). METHODS: A prospective, uncontrolled study of 39 pulmonary tuberculosis patients, who had received adequate first-line antituberculosis treatment including supervised category II retreatment regimen, and were still sputum smear positive for acid-fast bacilli (AFB) in whom sputum culture revealed isolates of M. tuberculosis resistant to rifampicin and isoniazid with and without resistance to other antituberculosis drugs. They received kanamycin (initial 4-6 months), ethionamide, isoniazid, PAS and cycloserine for a minimum period of two years. RESULTS: Out of 39 patients, 29 (74.3%) achieved sputum conversion within six months and remained so at the end of two years. Two (5.1%) patients died, six (20.6%) patients were lost to follow up, and two (5.1%) patients remained sputum smear-positive for AFB through out the period of study. Twenty-nine patients, declared cured, were followed for an average period of 16 months (3-48 months), during which two (6.9%) patients relapsed, four (13.8%) patients were lost to follow-up and remaining 23 remained sputum smear-negative. Eight (21.1%) patients developed major side effects which required stoppage/change of drugs. CONCLUSION: In MDR-TB patients, regimen consisting of ethionamide, isoniazid, PAS and cycloserine and kanamycin appears to be effective and safe.

To study the outcome of patients with Multi-Drug Resistant Tuberculosis and see the effectiveness of second line drugs available in Pakistan in the management of MDR TB

MDR TB is a difficult problem to treat specially in countries like Pakistan, where facilities to treat the patients in hospital for the whole course of treatment are limited and also all the effective second line drugs are not available. This study was aimed to see the effectiveness of second line drugs that are available in Pakistan in terms of sputum conversion and cure rate and to see the resistance pattern of MDR TB. This study was carried out from 1st March 1995 to 31st Dec 2001 in a Chest Clinic in Peshawar. All patients having active Pulmonary Tuberculosis with history of irregular treatment in past were included in the study irrespective of age and sex. Their sputum samples were sent for AFB culture and sensitivity and they were started on second line anti tuberculosis drugs. The pattern of drug resistance was noted from results of culture and sensitivity results, when available. The progress of the patient was monitored by clinical assessment, sputum examination and Chest Radiographs on subsequent follow up visits monthly for first three months and then at 2-3 months intervals until completion of treatment. 70 patients, [40 males and 30 females] were included in the study. 05 patients excluded after their sputum C/S showed that they were not having MDR TB. 38% patients had bacilli resistant to all 06 first line drugs, 20% resistant to 05% drugs, 25% resistant to 04 drugs, 12% resistant to 3% drugs and only 05% were only resistant to 02 drugs i-e Rifampicin and INH. Regimen used was Kanamycin 15 mg/kg, Ofloxacin 400-800 mg/day, PAS 150 mg/kg, Ethionamide 15 mg/kg and Thiacetazone and INH 2.5 and 5 mg / kg respectively. The regimen was modified after C/S report with addition of first line drugs to which the bacilli were sensitive. At the end of 02 months the conversion the conversion rate was 79%. Treatment Outcome: 55% patients were cured, 21% lost, 10% had treatment failure and 2% reported dead. Half of the patients cured have been attending for optional follow up for the period ranging from 1 to 6 years and only two patients have relapsed so for. The second line drugs that are available in Pakistan are effective both in terms of sputum conversion and achieving cure. Large number of patients lost signifies the fact that these patients need to be hospitalized and treated under direct supervision for the whole period of treatment as recommended

Colon-specific delivery tablets of sodium 4-aminosalicylic acid / 药学学报

<p><b>AIM</b>To prepare a new oral colon-specific delivery formulation and to investigate the release profile in vitro and the colon-specific delivery property in vivo in dogs.</p><p><b>METHODS</b>Sodium 4-aminosalicylic acid was selected as the model drug. The combination of Eudragit RL30D and RS30D were used as sustained-release film, and Eudragit FS30D used as enteric film, which was expected to release drug depending on pH and time. The release profile of tablets was studied in three phosphate buffers with the pH 6.5, 7.0 or 7.4 for 12 h after a simulated gastric presoak for 2 h in 0.1 mol x L(-1) HCl. The tablets were radiolabelled with 99mTc to make their release times and positions in the gastrointestinal tract be followed using a gamma camera.</p><p><b>RESULTS</b>For the in vitro study, there was no drug released in 0.1 mol x L(-1) HCl for 2 h, and release occurred slowly when pH was above 6.5. Drug was released faster while pH was higher. For the in vivo study, the coated tablets remained intact in the upper gastrointestinal tract, and drug release began after the colonic arrival. The uncoated tablets, however, disintegrated in the stomach of the dogs rapidly.</p><p><b>CONCLUSION</b>The coating could protect the drug until the tablets reached the ascending colon, where drug was released slowly for over 10 h.</p>

Glándulas linguales de Blandin y Nuhn; estudio histoquímico de los glicoconjugados de las células serosas y mucosas / Blandin and Nuhn lingual glands; an histochemical study of serous and mucous sugars

Se emplearon las técnicas histoquímicas convencionales para mucinas (PAS, Alcian blue y Azul de toluidina) y la técnica de avidina-biotina para estudiar la unión de las lectinas PNA, UEA-1, RCA-1, ConA, DBA, SBA y WGA a los azúcares específicos en cortes histológicos de glándulas inguales anteriores de Blandin y Nuhn. Las células secretoras mucosas y serosas exhibieron diferentes grados de coloración dependiendo de la lectina y el tipo celular. Estos resultados proveen las bases para la comparación de posibles cambios en las enfermedades de las glándulas salivales menores

An Analysis of Antituberculosis Drug Susceptibility Test Results in Kyung Hee Medical Center During Recent Four years / 대한임상미생물학회지

BACKGROUND: Tuberculosis is still one of the most seriously threatening infections in Korea, because of multidrug resistant tuberculosis. Results of antituberculosis drug susceptibility test can provide clinicians very important informations for selection of proper regimens for treatment. METHODS: In this study the results of antituberculosis drug susceptibility test of 298 cases at Kyunghee Medical Center from 2000 to 2003 were retrospectively analysed to evaluate the trend of antituberculosis drug susceptibility. The procedure of drug susceptibility test was based on the absolute concentration method using Lowenstein-Jensen solid media. RESULTS: The resistance rate of Mycobacterium tuberculosis to one or more drugs was increased from 29.3% in 2000 to 48.2% in 2003, and the rates of multiple resistance to two or more drugs increased from 13.3% in 2000 to 20.5% in 2003. The increase in resistance rate to individual drug during study period were 20.0% to 24.1% in isoniazid, 9.3% to 19.3% in rifampicin, 5.3% to 15.7% in ethambutol, 4.0% to 10.8% in para-aminosalicylic acid, 2.7% to 6.0% in kanamycin, 1.3% to 7.2% in ethionamide, 1.3% to 6.0% in capreomycin, 1.3% to 7.2% in prothionamide, 0.0% to 12.1% in ofloxacin, 6.7%to 3.6% in streptomycin, 6.7% to 7.2% in cycloserine, 10.7% to 8.4% in pyrazinamide, respectively. CONCLUSIONS: The resistance rate of M. tuberculosis has been increased with years and multidrug resistant M. tuberculosis was commonly encountered in the specimens from the patients visited Kyunghee Medical center.

Tratamiento de liquen plano con griseofulvina / Treatment of lichen planus with griseofulvin

Presentamos un paciente de sexo masculino, de 15 años de edad, con diagnóstico clínico e histopatológico de liquen plano. Fue tratado con griseofulvina 500 mg/día y fenoxifenadina 120 mg/día con mejoría tanto subjetiva como objetiva al cabo del mes de tratamiento. Se confirma la griseofulvina como alternativa terapéutica para el liquen plano

Pharmacokinetics of ofloxacin in Patients with Multidrug-Resistant Tuberculosis / 결핵

BACKGROUND: There are few studies that have reported on the pharmacokinetic(PK) disposition of fluoroquinolones in patients with multi-drug resistant tuberculosis(MDR-Tb), even though fluoroquinolones are frequentl y co-prescribed to those patients. In this study, the PK disposition of ofloxacin, a fluoroquinolone, was evaluated in patients with MDR-Tb. METHODS: Twenty patients with MDR-Tb were given 2nd line Tb drugs including ofloxacin (300mg twice a day), prothionamide, cycloserine, para-aminosalicylic acid, kanamycin, and streptomycin. The patients were grouped according to their body mass index(BMI) as an index of emaciation (group A: 18.5

Clinical Effects of Prothinoamide, Cycloserine, Para-Aminosalicylic Acid, Ofloxasine in Retreatment of Pulmonary Tuberculosis / 결핵

BACKGROUND: Antituberculous therapy is set a short-term therpy used isoniazid(INH), rifampin(RFP), ethambutol(EMB), pyrazinamide(PZA) from 1970s' and treatment rate has been very improved. But drug interruption or irregular medication due to side effects and resistance of drug are serious problem to retreatment cases, specially. Ofloxasine(OFX), developed from Quinolone at 1980's is effective not only other respiratory infectious disease but also pulmonary tube rculosis. And this is useful drug instead of injection agents for retreatment patients who have side effects to other drugs, lived far distance from medical clinics. So, we will evaluate theffectiveness as four oral drags involving OFX. METHOD: A retrospective study was made through the regular follow up of smear positive cases,who treated by four drag, namely, prothionamide (PTA) cycloserine(CS), OFX, paraminosalicylic acid(PAS). RESULTS: 1) Out of 66case with positive sputum AFB smear, 42(64%)cases achieved the negative conversion. 2) Considering the negative conversion in all group, 34 case (52%) of sputum conversion occured within first 6 months, on the extent of diease was minimal, moderate, far advavanced pulmonary tuberculosis, sputum AFB smear negative response to treatment was 100%, 78% , 46% respectively. 3) The roentgenological improvement occured in 38(58%), extent of diease was minimal, moderately, far advanced pulmonary tuberculosis, Roentgenological improvement to retreatment was 75%, 64%, 46%. 4) When the duration of patients illness was less than 1 year, 1 to 3 years, 3 to 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 100%, 88%, 80%, 52%. 5) On side effects, major problems are gastrointestinal troubles, mild liver function abnormality, psychotic problemes, and skin problem(urticaria, itching sensation). CONCLUSION: The duration & extents of patients illness was shorter & minimal, sputum AFB smear negative response rate was better. Radiologic response is better as shorter duration and minimal extent of diease. But, as diease is longer duration & far advanced, sputum negative conversion & Roentgenological improvement is poor and limited. The adverse reaction was mainly observed gastrointestinal troubles(indigestion, abdominal pain, nausea, vomiting, diarrhea) and are well controled by symptomatic management in most patients, as regard to tolerance to the secondary drugs.

Clinical Effects of Prothinoamide, Cycloserine, Para-Aminosalicylic Acid, Ofloxasine in Retreatment of Pulmonary Tuberculosis / 결핵

BACKGROUND: Antituberculous therapy is set a short-term therpy used isoniazid(INH), rifampin(RFP), ethambutol(EMB), pyrazinamide(PZA) from 1970s' and treatment rate has been very improved. But drug interruption or irregular medication due to side effects and resistance of drug are serious problem to retreatment cases, specially. Ofloxasine(OFX), developed from Quinolone at 1980's is effective not only other respiratory infectious disease but also pulmonary tube rculosis. And this is useful drug instead of injection agents for retreatment patients who have side effects to other drugs, lived far distance from medical clinics. So, we will evaluate theffectiveness as four oral drags involving OFX. METHOD: A retrospective study was made through the regular follow up of smear positive cases,who treated by four drag, namely, prothionamide (PTA) cycloserine(CS), OFX, paraminosalicylic acid(PAS). RESULTS: 1) Out of 66case with positive sputum AFB smear, 42(64%)cases achieved the negative conversion. 2) Considering the negative conversion in all group, 34 case (52%) of sputum conversion occured within first 6 months, on the extent of diease was minimal, moderate, far advavanced pulmonary tuberculosis, sputum AFB smear negative response to treatment was 100%, 78% , 46% respectively. 3) The roentgenological improvement occured in 38(58%), extent of diease was minimal, moderately, far advanced pulmonary tuberculosis, Roentgenological improvement to retreatment was 75%, 64%, 46%. 4) When the duration of patients illness was less than 1 year, 1 to 3 years, 3 to 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 100%, 88%, 80%, 52%. 5) On side effects, major problems are gastrointestinal troubles, mild liver function abnormality, psychotic problemes, and skin problem(urticaria, itching sensation). CONCLUSION: The duration & extents of patients illness was shorter & minimal, sputum AFB smear negative response rate was better. Radiologic response is better as shorter duration and minimal extent of diease. But, as diease is longer duration & far advanced, sputum negative conversion & Roentgenological improvement is poor and limited. The adverse reaction was mainly observed gastrointestinal troubles(indigestion, abdominal pain, nausea, vomiting, diarrhea) and are well controled by symptomatic management in most patients, as regard to tolerance to the secondary drugs.