• Title/Summary/Keyword: 병합요법

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폐포자충 폐렴, 기회질환 사망의 주요 원인

  • 김신우
    • RED RIBBON
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    • s.63
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    • pp.8-9
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    • 2005
  • 폐포자충 폐렴은 과거 에이즈 환자의 표지질환이었으나 최근 적절한 항바이러스제의 병합요법(HAART)과 예방요법으로 환자들이 많이 감소하였다. 적절한 병합요법과 예방요법을 시행하면 폐포자충 폐렴의 발생률은 $0\%$에 가깝다. 그러므로 적절한 시기에 HAART와 같은 예방요법을 시행하는 것이 발생의 예방을 위해 가장 중요하다.

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Cost-Effectiveness Analysis of Glimepiride or Pioglitazone in Combination with Metformin in Type-2 Diabetic Patients (제2형 당뇨병 환자에 대한 메트포르민-글리메피리드 병합요법과 메트포르민-피오글리타존 병합요법의 비용-효과분석)

  • Lim, Kyung-Hwa;Shin, Hyun-Taek;Sohn, Hyun-Soon;Oh, Jung-Mi;Lee, Young-Sook
    • Korean Journal of Clinical Pharmacy
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    • v.19 no.2
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    • pp.96-104
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    • 2009
  • 배경: 당뇨병 환자에게 관상동맥심질환은 생존률, 건강 상태 유지 및 삶의 질에 주요한 영향을 미치는 합병증이며 적극적인 당뇨병 치료는 이러한 심혈관 합병증을 예방할 수 있으나 당뇨병의 적극적 치료와 관리에는 많은 비용이 소요된다. 목적: 제2형 당뇨병 환자를 대상으로 메트포르민과 글리메피리드 병합요법과 메트포르민과 피오글리타존 병합요법의 비용-효과성을 비교하고자 하였다. 연구방법: 마르코프 코호트 프로세스(Markov Cohort Process Model) 모형을 이용하여 비용-효과분석을 실시하였다. 연장된 수명 (life years gained, LYG)과 삶의 질(quality)을 보정하여 증가된 QALYs를 주요 효과 지표로 측정하였고, 총비용으로는 직접의료비용과, 환자와 가족의 교통비를 직접비의료비용으로 고려하였고 환자와 가족의 시간비용을 간접비용으로 포함하였다. 연구결과: 비용-효과분석 결과, 메트포르민과 글리메피리드 병합요법의 경우 총 비용은 5,962,288원, 효과는 7.94LYG, 6.43QALY이었다. 반면 메트포르민과 피오글리타존 병합요법은 총 비용 10,982,243원, 효과 8.62LYG, 6.99QALY으로, 점증적 비용-효과비(ICER)는 7,402,663원/LYG과 8,934,546원/QALY 이었다. 결론: 우리 사회의 연장된 수명(LYG)에 따른 지불의사가 700만원 이하인 경우는 메트포르민과 글리메피리드 병합요법이 비용-효과적인 대안이며 700만원 이상인 경우에는 메트포르민과 피오글리타존 병합요법이 비용-효과적인 대안이 될 수 있다.

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A Case of Metastatic Pancreatic Cancer Treated with FOLFIRINOX as Second-Line Chemotherapy after Gemcitabine Failure (FOLFIRINOX 병합요법을 통한 이차 항암화학요법으로 완전 관해를 획득한 진행성 췌장암 증례)

  • Jae Min Lee;Kwang Hyun Chung;Jin Myung Park;Sang Hyub Lee;Ji Kon Ryu;Yong-Tae Kim
    • Journal of Digestive Cancer Research
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    • v.2 no.1
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    • pp.28-31
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    • 2014
  • Pancreatic cancer is a highly aggressive cancer with poor prognosis. Although, gemcitabine is the current standard regimen as first-line chemotherapy for advanced pancreatic cancer, effective regimens of second-line chemotherapy after gemcitabine failure have not been established yet. We report a case of gemcitabine refractory pancreatic cancer treated with second-line chemotherapy with FOLFIRINOX regimen. A 57-year-old-woman visited our hospital for pancreatic body mass detected by computed tomography (CT). The patient underwent distal pancreatectomy and splenectomy and the pathologic results after surgery demonstrated adenocarcinoma. Follow-up was performed after surgery and CT and positron emission tomography (PET) 4 months after surgery revealed multiple hepatic metastases. The patient underwent first-line chemotherapy with gemcitabine and erlotinib for recurred pancreatic cancer. However, CT after 7 cycles of the chemotherapy showed the progression of multiple hepatic metastases and switch to second-line chemotherapy with FOLFIRINOX was initiated. CT after 16 cycles of the FOLFIRINOX showed the complete remission of multiple hepatic metastases. The patient was admitted for infective endocarditis with septic pneumonia 17 months after the initiation of FOLFIRINOX. However, the patients died from the progression of septic embolism and acute respiratory distress syndrome.

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Outcome of High Dose AmpicillinSulbactam and Colistin Combination Therapy for Treating VentilatorAssociated Pneumonia Caused by Carbapenem-Resistant Acinetobacter baumannii: a Pilot Study (Carbapenem내성 Acinetobacter baumannii로 인한 인공호흡기연관 폐렴 환아에서 고용량 Ampicillin-Sulbactam 과 Colistin 항균제 병합요법의 치료적 예후: 예비 연구)

  • Jeong, Seong Hee;Kim, Young A;Choi, Go-eun;Park, Su Eun
    • Pediatric Infection and Vaccine
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    • v.27 no.1
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    • pp.45-52
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    • 2020
  • Purpose: This pilot study aimed to evaluate the efficacy of high dose ampicillin-sulbactam and colistin combination therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in the pediatric intensive care unit of Pusan National University Children's Hospital. Methods: We retrospectively reviewed 17 pediatric patients with VAP caused by CRAB from June 2017 to August 2018. Ten (58.8%) patients were treated with high dose ampicillin-sulbactam and colistin combination therapy (combination therapy group), whereas 7 were treated with colistin only or with various combinations with or without colistin (other antibiotics group). Clinical and bacteriological outcomes were compared between the groups. Results: The mean duration of fever after antibiotic use was 1.30±1.70 days in the combination therapy group and 1.71±1.49 days in the other antibiotics group. The mean duration of days for negative conversion of endotracheal aspirate bacterial culture after antibiotic therapy was 3.40±1.71 days in the combination therapy group and 11.80±8.86 days in the other antibiotics group. The mortality rate within 30 days of antibiotic therapy was 1/10 (10%) in the combination therapy group and 3/7 (42.9%) in the other antibiotics group. Conclusions: High dose ampicillin-sulbactam and colistin combination therapy as early antibiotic treatment in VAP caused by CRAB in children could improve clinical outcomes.

Effect of Antibiotic Combination Therapy on Metallo-${\beta}$-Lactamase Producing Imipenem Resistant Pseudomonas aeruginosa (Metallo-${\beta}$-lactamase를 생성하여 Imipenem에 내성인 Pseudomonas aeruginosa에 대한 항균제 병합요법의 효과)

  • Hong, Seung-Bok;Kim, Hong Chul;Lee, Jang-Won;Son, Seung-Yeol
    • Korean Journal of Microbiology
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    • v.44 no.4
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    • pp.339-345
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    • 2008
  • This study was to detect MBL (metallo-${\beta}$-lactamase) among glucose non-fermenting Gram-negative bacilli isolated from clinical specimen and to search antimicrobial combination therapy against MBL producing Pseudomonas aeruginosa. Among fifty one isolates of Gram-negative bacilli with reduced imipenem susceptibility ($MIC{\ge}8{\mu}g/ml$), nine isolates have shown positive results in MBL detection test. They were seven Achromobacter xylosoxidans subsp. xylosoxidans and two P. aeruginosa. The results from EDTA-DDST coin-cided with those of PCR and nucleotide sequence analysis which showed the presence of $bla_{VIM-2}$. The combination of aztreonam (AZT) and piperacillin-tazobactarn (TZP) or AZT and amikacin (AN) screened by one disk synergy test showed no synergistic effect. Triple antibiotic combination therapy with AZT, TZP and AN, however, was shown to be effective and the most synergistic after 8 hrs of exposure. This result strongly suggest that the triple combination therapy of AZT, TZP, and AN could be useful for the treatment of infection caused by MBL producing Gram-negative bacilli.

Combination Treatment with Arsenic Trioxide and Sulindac Induces Apoptosis of NCI-H157 Human Lung Carcinoma Cells via ROS Generation with Mitochondrial Dysfunction (NCI-H157 폐암 세포주에서 활성산소종의 생성과 미토콘드리아 기능변화를 한 Arsenic Trioxide와 Sulindac 병합요법의 세포고사효과)

  • Kim, Hak-Ryul;Yang, Sei-Hoon;Jeong, Eun-Taik
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.1
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    • pp.30-38
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    • 2005
  • Background : Arsenic trioxide ($As_2O_3$) has been used to treat acute promyelocytic leukemia, and it induces apoptosis in a variety of solid tumor cell lines including non-small cell lung cancer cells. However, nonsteroidal antiinflammatory drugs (NSAID) can enhance tumor response to chemotherapeutic drugs or radiation. It was previously demonstrated that a combination treatment with $As_2O_3$ and sulindac induces the apoptosis of NCI-H157 human lung carcinoma cells by activating the caspase cascade. This study aimed to determine if a combination treatment augmented its apoptotic potential through other pathways except for the activation of the caspase cascade. Material and Methods : The NCI-H157 cells were treated with $As_2O_3$, sulindac and antioxidants such as glutathione (GSH) and N-acetylcysteine (NAC). The cell viability was measured by a MTT assay, and the level of intracellular hydrogen peroxide ($H_2O_2$) generation was monitored fluorimetrically using a scopoletin-horse radish peroxidase (HRP) assay. Western blotting and mitochondrial membrane potential transition analysis were performed in order to define the mechanical basis of apoptosis. Results : The viability of the cells was decreased by a combination treatment of $As_2O_3$ and sulindac, and the cells were protected using antioxidants in a dose-dependent manner. The increased $H_2O_2$ generation by the combination treatment was inhibited by antioxidants. The combination treatment induced changes in the mitochondrial transmembrane potential as well as the expression of the Bcl-2 family proteins, and increased cytochrome c release into the cytosol. However, the antioxidants inhibited the effects of the combination treatment. Conclusion : Combination treatment with $As_2O_3$ and sulindac induces apoptosis in NCI-H157 human lung carcinoma cells via ROS generation with a mitochondrial dysfunction.