<原著>抗結核薬の副作用とその軽減法

Abstract

In the clinical study of the intensification of the effect of antituberculosis chemotherapy, it is one of the most important tasks to avoid the side effects caused by antituberculosis agents. The author, with several collaborates, has been studied about this problem including drug-allergy and experienced that there are fairly many cases dropped out of the intensified regimen because of the various side effects. In this report, the author's experiences on the incidences and the preventive measures for each drug are discussed with some references. As for Streptomycin (SM) and Kanamycin (KM), ototoxicity is main cause of cessation of the treatment and its incidence is estimated about 4-5% for audiometry. According to the clinical results, the injection of SM or KM in the evening before going to sleep is efficacious in reducing the ototoxicity but the mechanism is not well explained. Gastric disturbance caused by ethionamide is prevented or reduced fairly by using prothionamide or by giving the tolerable maximum of ethionamide before going to sleep and the rest divided after meal. Cycloserine (CS) is noted as the occasional cause of neuropathic disorder especially in older patients at the rate over 10% and it is shown that the incidence of this side effect can be reduced by decreasing the daily dose of CS as 0.375g. in the patients over 60 years of age and/or under 40kg of body weight. Ethambutol (EB) is known to attack the optic nerve selectively but the disturbances are mostly reversible and they are detectable in the early stage by careful observation at the bed-side in the prevailing daily dose of lg. of EB (d-form). As the counter measure to the drug-allergy caused mainly by SM and/or PAS, the modified method of which reported initially by D. G. Simpson, is evaluated as fairly successful to get over the allergic symptoms in relatively short interruption of the chemotherapy of tuberculosis.