Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Treatment of Isoniazid-Resistant Pulmonary Tuberculosis

Isoniazid 내성 폐결핵의 치료실태와 치료성적

  • Koh, Won-Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, O Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yu, Chang-Min (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeon, Kyeongman (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kyung Chan (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Byoung-Hoon (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hwang, Jung Hye (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Eun Hae (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Suh, Gee Young (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Man Pyo (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hojoong (Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 고원중 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 권오정 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 유창민 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 전경만 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 김경찬 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 이병훈 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 황정혜 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 강은해 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 서지영 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 정만표 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학) ;
  • 김호중 (성균관대학교 의과대내과학교실, 삼성서울병원 호흡기내과학)
  • Published : 2004.03.30
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Abstract

Background : As an effective regimen for isoniazid (INH)-resistant pulmonary tuberculosis, several treatment regimens have been recommended by many experts. In Korea, a standard regimen has not been established for INH-resistant tuberculosis, and the treatment by individual physicians has been performed on an empirical bases. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the treatment outcomes of patients with INH-resistant tuberculosis. Materials and Methods : Sixty of 69 patients reported to have INH-resistant tuberculosis from 1994 to 2001 were retrospectively analyzed. Exclusion criteria included: death from other causes, with the exceptions of tuberculosis and incomplete treatment, including a patient's transfer-out. Results : A previous tuberculosis history was found in 28 (46.7%) patients. The sputum smear for acid-fast bacilli was positive in 44 (73.3%) patients, and 30 (50.0%) had cavitary disease. Streptomycin resistance coexisted in 25.0% of isolates. INH was to be prescribed continuously, even after INH resistance was reported, in 86.0% of patients. The treatment regimens were diverse between the patients according to drug regimen composition and treatment duration. The most frequent prescribed regimen included rifampin, ethambutol and pyrazinamide, with and without INH, for the full 12-month term of treatment. Treatment failure occurred in 13 (21.7%) patients. Cavitary disease (p=0.005) and a treatment regimen with second-line drugs, excluding rifampin (p=0.015), were associated with treatment failure. One patient experienced a relapse. Conclusions : Standardized treatment guidelines will be needed in Korea to improve the treatment efficacy for INH-resistant tuberculosis.

연구배경 : INH 내성률은 국내 초치료 폐결핵 환자의 10%, 재치료 환자의 20%에 달하지만 아직까지 국내 치료지침이 정립되지 않은 실정이다. 본 연구는 INH 내성폐결핵의 치료실태와 치료성적을 알아보고자 하였다. 방 법 : 1994년 10월부터 2001년 12월까지 삼성서울병원에서 객담에서 배양된 결핵균에 대해 약제감수성검사를 시행하여 다제내성을 제외한 INH 내성이 확인된 69명의 폐결핵 환자 중 6개월 이상 치료를 시행한 60명의 환자를 대상으로 후향적 조사를 시행하였다. 결 과 : 획득내성이 28명(46.7%), 객담도말양성이 44명(73.3%), 공동이 30명(50.0%)에서 관찰되었다. INH가 처방된 50명 중 INH 내성이 확인된 후 INH를 제외한 환자는 7명(14.0%)이었다. 치료약제와 치료기간은 다양하였으며, RIF, EMB, PZA를 12개월간 사용한 경우가 11명(18.3%)으로 가장 많았다. 치료결과는 완치 27명(45.0%), 균음전을 확인하지 못한 치료종결이 20명(33.3%)으로 치료성공이 47명(78.3%), 치료실패가 13명(21.7%)이었다. 공동이 있는 경우(p=0.005)와 RIF이 포함되지 않고 2차 약제만으로 치료처방을 구성한 경우(p=0.015)에 치료실패율이 높았다. 한 명의 환자에서 재발이 관찰되었다. 결 론 : INH 내성 폐결핵의 치료효율을 높이기 위해서 표준화된 국내 치료지침의 제정이 필요하리라 사료된다.

Keywords

References

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