약제 감수성 폐결핵 환자의 초 치료 중 발생한 다제내성 결핵
Development of Multidrug Resistance during Standardized Treatment in a Patient with Drug-Sensitive Tuberculosis
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초록
폐결핵의 초치료에서 표준 단기약물요법의 사용은 내성결핵의 발현을 줄일 수 있는 최선의 방법으로 받아들여지고 있다. 그러나 적절한 치료에도 불구하고 내성을 획득하여 다제내성결핵으로 진행한 이 증례는 표준 단기 약물요법이 일부 환자에게는 내성 획득을 완전히 예방할 수는 없을 수도 있다는 점을 시사한다.
Abstract
Standard short-course chemotherapy (SSC) is recommended for new patients with pulmonary tuberculosis (TB). This approach has been regarded as among the most effective tools for preventing the development of resistance to anti-TB drugs. We report on the development of multidrug-resistance during SSC in a patient with drug-susceptible TB. Isoniazid, rifampin, pyrazinamide, and ethambutol were started, and negative culture conversion was obtained. Ethambutol was discontinued after 5 weeks of treatment due to visual dysfunction, and pyrazinamide was discontinued after a 2-month phase of intensive treatment. However, M. tuberculosis was cultivated from sputum collected after 9 weeks of treatment. Drug-susceptibility testing revealed resistance to isoniazid, rifampin, ethambutol, and rifabutin. Given that the patient took medication regularly, this observation suggests the possibility that some patients acquire drug resistance during SCC. (Korean J Med 2012;82:614-617)
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