• 作者： 楊思標; 陸坤泰; 欒筱文; 張正二
• 作者服務機構： 國立臺灣大學醫學院醫學系; 臺灣省防癆局
• 中文摘要： Despite the discovery of effective antituber-culous drugs,“long term administration”hasteen regarded as one of the main obstaclesagainst success of TB control especially indeveloping countries. With the discovery ofRifampicin (RIF), however, 6 months adminis-tration of INH+RIF has been claimed as suffi-cient and satisfactory for the initial treatmentcases. The curable rate is estimated as 98% andrelapse rate as 2% within 2 years after discon-tinuation of the treatment. The primary purpose of this study is to findout whether the duration of treatment can becut even shorter, preferably 3 months, by com-bining the four most potent antituberculousdrugs. A clinical trial of short term intensivechemotherapy has been carried out since May1974 at the Provincial Tuberculosis ControlBureau in cooperation with National TaiwanUniversity Hospital. To compromise with olderconcept that TB treatment has to be long term,the drug regimen adopted by us consists of twophases; initial intensive chemotherapy with INH,SM, EMB and RIF daily; is given for at first3 months, till the target point, that is sputumconverted, cavity closed and 3/4 of the lesionsabsorbed, is reached (the first phase). It is fol-lowed by INH monotherapy or INH+EMB, inwhom INH was found to be primarily resistant,for another 12 months (the second phase). Ifthe target point is not reached by the end of 3months' intensive treatment, it is extended andevaluated on monthly basis for at most 3 months.If the target point has not reached by 6 monthsof intensive chemotherapy the treatment is re-garded as failure. The efficacy of treatment isevaluated by conversion of positive sputum,improvement of chest X-ray findings, namelycavity closure and absorption of lesions, and rateof relapse. Adverse effect is also observed. Altogether 60 cases of newly diagnosedmoderately or far advanced active pulmonarytuberculosis, have entered in this study and bynow all have finished the intensive chemotherapy,19 under second phase monotherapy, 41 havecompleted the second phase treatment and underfollow-up observation, among them 2 have al-ready exceeded 1 year follow-up period. Although the overall result of the clinicaltrial has to wait a couple of years to clarifythe relapse rate, the preliminary result up tonow shows: 1. 70.3%, 93.3%, 98.3% and 100% ofsputum conversion rate were observed within1, 2, 3 and 4 months respectively. 2. In about 60% of cases, the target pointcan be reached and intensive chemotherapyterminated in 3 months, 70.0% in 4 months,76.7% in 5 months, 95.0% in 6 months. Theremaining 3 cases (5%) did not reach the targetpoint because of open negative cavity andmultiple tuberculoma. 3. No relapse case has been found so faramong those who had discontinued the drug. 4. No case terminated the treatment be-cause of side-effects. 5. In 2cases, the lesions were resected after3 months of intensive chemotherapy. Culturefor tubercle bacilli from the tissue homoginatewere proved to be negative. And the furtherchest X-ray improvement was seen in the 3failure cases during the monotherapy (3ndphase). So, the intensive chemotherapy maybring about bacteriocidal effect to the tubercu-lous lesions. 6. Further study may be carried out to seewhether 2nd phase monotherapy is really neces-sary.
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