노인 폐결핵의 치료
Treatment of pulmonary tuberculosis in elderly
1
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Although the incidence of tuberculosis has declined dramatically recently, tuberculosis is still one of the great public health problems in South Korea. Older persons are more susceptible to tuberculosis than younger persons. Older pulmonary tuberculosis patients may have few symptoms and atypical radiographic findings, so clinicians need to have high index of suspicion to make a diagnosis of pulmonary tuberculosis. The basic approach to treatment of tuberculosis in elderly is the same as in younger patients. Standard chemotherapy of drug susceptible tuberculosis consists of a 2-months intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4-months maintenance phase (isoniazid, rifampin, ethambutol). Vitamin B6 (pyridoxine) is usually given to prevent isoniazid induced peripheral neuropathy which is more common in elderly patients. Older tuberculosis patients are more susceptible to adverse effects of anti-tuberculosis drugs. Monitor liver function and educate elderly patients and their family members about the signs and symptoms of adverse drug reactions and encourage to report promptly to their physician any of adverse drug reactions. Compliance to treatment of elderly tuberculosis patients is poor due to frequent co-morbid conditions and low socioeconomic conditions. Public-private collaboration will improve the compliance of elderly tuberculosis patients managed in private hospitals. (Korean J Med 75:141-148, 2008)
Abstract
Although the incidence of tuberculosis has declined dramatically recently, tuberculosis is still one of the great public health problems in South Korea. Older persons are more susceptible to tuberculosis than younger persons. Older pulmonary tuberculosis patients may have few symptoms and atypical radiographic findings, so clinicians need to have high index of suspicion to make a diagnosis of pulmonary tuberculosis. The basic approach to treatment of tuberculosis in elderly is the same as in younger patients. Standard chemotherapy of drug susceptible tuberculosis consists of a 2-months intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4-months maintenance phase (isoniazid, rifampin, ethambutol). Vitamin B6 (pyridoxine) is usually given to prevent isoniazid induced peripheral neuropathy which is more common in elderly patients. Older tuberculosis patients are more susceptible to adverse effects of anti-tuberculosis drugs. Monitor liver function and educate elderly patients and their family members about the signs and symptoms of adverse drug reactions and encourage to report promptly to their physician any of adverse drug reactions. Compliance to treatment of elderly tuberculosis patients is poor due to frequent co-morbid conditions and low socioeconomic conditions. Public-private collaboration will improve the compliance of elderly tuberculosis patients managed in private hospitals. (Korean J Med 75:141-148, 2008)
참고문헌 (22)
- Dye C, "Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally", JAMA, 293, pp.2767~2775 (2005)
- Dutt AK, "Tuberculosis in the elderly", Med Clin North Am, 77, pp.1353~1369 (1993)
- Stead WW, "Pathogenesis of a first episode of chronic pulmonary tuberculosis in man: recrudescence of residuals of primary infection or the exogenous reinfection?", Am Rev Respir Dis, 95, pp.729~745 (1967)
- Tocque K, "Long-term trends in tuberculosis. Comparison of age-cohort data between Hongkong and England and Wales", m J Respir Crit Care Med, 158, pp.484~488 (1998)
- Keane J, "Tuberculosis reactivation during immunosuppressive therapy in rheumatic diseases: diagnostic and therapeutic strategies", Curr Opin Rheumatol, 4, pp.443~449 (2008)
- 이재호, "노인 폐결핵의 임상적", 결핵 및 호흡기질환, 51, pp.334~345 (2001)
- Mackay AD, "The problems of tuberculosis in the elderly", Q J Med, 212, pp.497~510 (1984)
- 김정태, "고령자 폐결핵에 대한 임상적 고찰", 결핵 및 호흡기질환, 49, pp.432~440 (2000)
- Lee JJ, "High resolution chest CT in patients with pulmonary tuberculosis; characteristic findings before and after antituberculous therapy", Eur J Radiol, 67, pp.100~104 (2008)
- 이정연, "한 대학병원에서 비결핵항산균의 분리 및 동정실태", 결핵 및 호흡기질환, 58(4), pp.385~391 (2005), 대한결핵및호흡기학
- Taegtmever M, "The clinical impact of nucleic acid amplification tests on the diagnosis and management of tuberculosis in a British hospital", Thorax, 63, pp.317~321 (2008)
- 고원중, "비결핵 항산균 폐질환의 진단과 치료", 대한내과학회지, 74, pp.120~131 (2008)
- Blumberg HM, "American thoracic society", Centers for disease control and prevention, Am J Respir Crit Care Med, pp.2003, 167[DOI]
- de Groot CP, "Energy intake and micronutrient intake in elderly Europeans: seeking the minimum requirement in the SENECA study", Age Ageing, 28, pp.469~474 (1999)
- Chan CH, "Adverse drug reactions and outcome of elderly patients on antituberculous chemotherapy with and without rifampin", J Med, 26, pp.43~52 (1995)
- Finch CK, "Rifampin and rifabutin drug interactions. An update", Arch Intern Med, 162, pp.985~992 (2002)
- Gronhagen-Riska C, "Predisposing factors in hepatitis induced by isoniazid-rifampin treatment of tuberculosis", Am Rev Respir Dis, 118, pp.461~466 (1978)
- Tsai RK, "Reversibility of ethambutol optic neuropathy", J Ocul Pharmacol Ther, 13, pp.473~477 (1997)
- Goble M, "Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin", NEJM, 328, pp.527~532 (1993)
- 이창우, "폐결핵 환자의 항결핵제 복용의 순응도", 가정의학회지, 21, pp.684~692 (2000)
- Dewan PK, "Uplekar M, Sahu S, Granich R, Chauhan LS. Improving tuberculosis control through public-private collaboration in India: literature review", BMJ, 332, pp.574~578 (2006)
- 박기동, "민간 의료기관 결핵관리의 오늘과 내일", 결핵 및 호흡기질환, 52(6), pp.579~589 (2002), 대한결핵및호흡기학회