タイ国における結核の現状 : 結核化学療法の立場から

Abstract

It is estimated that in Thailand there are over 1, 200, 000 (about 4% of population) pulmonary tuberculsis patients to be treated, 300, 000 to 400, 000 patients among them with cavitary lesions or far-advanced lesions and at least 300, 000 patients with sputum positive for tubercle bacilli. From 1960, the tuberculosis control program of Thailand (especially of Bangkok) has been developed mainly in the field of mass-ambulatory-chemotherapy by sheer efforts of the staffs of Tuberculosis Control Division (Central Chest Clinic) supported by WHO and UNICEF. They are administering daily 0.3g. of isoniazid (INH) plus 10g. of PAS-Na or 0.15g. of TBl. Streptomycin (SM) is used in very few cases chiefly due to its expense. In fact, they have not more than 500 hospital beds for the isolation and the treatment of tuberculosis patients in Bangkok (Central Chest Hospital) and that is all in the whole Thailand now. So the most of the patients should be treated ambulatory. In spite of such severe social circumstances in Thailand, the effort seems to have been rewarded with good fruit. The author, however, wants to know whether there might be much more efficacious chemotherapeutic regimen suitable for ambulatory treatment. Concerning tuberculosis generally in Asian developing countries, it is one of the important tasks for Japanese doctors to investigate the most efficacious regimen of tuberculosis chemotherapy available to the ambulatory treatment. For this purpose, we must know at first about the results of the sensitivity tests against the prevailing tuberculostatic agents in all cases positive for tubercle bacilli. Then the results may directly reflect the effects of the regimens which they are using in Thailand and make it possible to evaluate the efficacy. We have planned to intensify the chemotherapeutic regimens in the original and re-treatment of pulmonary tuberculosis, and at present, we have some data (experimental and clinical) about the intensification of the regimens. The author believes that the chemotherapy of pulmonary tuberculosis in Thailand should be much more intensified in a realistic way. It is the best way in our field to make some contribution to the public health problem of Thai people.