非定型抗酸菌症の治療指針の評価 THE ESTIMATION OF THERAPEUTIC GUIDELINES AGAINST NON-TUBERCULOUS MYCOBACTERIOSIS
Mizutani estimated three therapeutic guidlines in US, UK and Japan. (1) MAC infection: In USA, CAM and AZM are the essential drugs and combination therapy with EB, RFP/RBT and SM were recommended by ATS in 1997. In UK, the administration of CAM and AZM are restricted to the cases of treatment failure or the relapsed cases. In Japan, though the efficacy of CAM and AZM have been well understood, these drugs are officially not recommended as key drugs yet, because recommended dosage of such medications by ATS are not covered by medical health insurance. In Japan and USA, one year is estimated enough to finish the treatment with the regimens include CAM or AZM. In UK, two years are recommended for treatment period. The New-Quinolons and TH are listed as the other drugs for medications, but all guidlines stated that these drugs are not so useful. (2) M kansasii infection: The all guidlines stated that RFP has an excellent activity against M kansasii. The usefulness of INH is disputable, therefore ATS recommended the regimen with HRE (INH, EB and RFP). It comes to the same recommendation in Japan, but BTS recommend the prescription with RFP and EB. (3) The rapid growers: The anti-tuberculous drugs are recommended for these species in UK, but the ATS guidline stated that anti-tuberculous drugs have no effect for such species.<BR>Harada evaluated the usefulness of the Japanese guideline of treatment for non-tuberculous mycobacteriosis (NTM), studying the outcome of treatment and the prognosis of pulmonary MAC disease for 50 cases of long term follow-up and 33 dead cases in his hospital. The results were as follows: (1) The dead cases were older and severer on chest X-ray features at starting of initial treatment, comparing survived cases which were observed for more than 5 years. In clinical patterns, a tuberculosis-like pattern of primary infection type and secondary infection type were more frequent in dead cases than in survived cases. (2) Among dead cases, the cases of tuberculosis-like pattern died earlier than the cases of diffuse bronchiectatic pattern, inclining to be in persistent bacillipositive condition. (3) In the long survivors more than 5 years, the rate of persistent bacilli-positive cases was 40%, but the rate of worsened cases on chest X-ray was 54%. (4) In long survivors, bacteriological prognoses are not correlative with the courses of chest X-ray features. (5) The bacteriological prognoses in 1-2 years of primarily treated cases following the Japanese guidline were better than the prognoses of other treated cases. These results showed that the prognoses of MAC patients were strongly affected by clinical features before treatment, and the Japanese guidline is useful for the treatment of pulmonary MAC disease.
結核 77(2), 95-98, 2002-02-15
JAPANESE SOCIETY FOR TUBERCULOSIS