RIFINAH用於BCG膀胱灌注的感染-义大医院.PPT

RIFINAH用於BCG膀胱灌注的感染 義大醫院 藥劑部 主講人:張逸芃 藥師 指導藥師:黃佳真 藥師 報告日期：99/9/30 Question Question Patient History 47歲，男性 Past history Urothelial carcinoma in situ of bladder Renal transplantation Hypertension Previous operation history End stage renal disease s/p cadarveric renal transplantation on 97/10/17 Transurethral resection of bladder tumor (TURBT) on 2010-04-27 巴斯德 BCG 免疫治療劑 (BCG Immunotherapeutic) DESCRIPTION ImmuCyst – 是由Bacillus Calmette-Guerin(BCG)之Connaught菌株(一種牛結核桿菌Mycobacterium bovis的活減毒菌株)製成的凍晶乾燥製劑 INDICATIONS 治療及預防膀胱原發或復發性原位癌(CIS)或經尿道切除術(TUR)後之表淺性乳頭瘤（Ｔa及Ｔ1） PHARMACOLOGY BCG promotes a local acute inflammatory and sub-acute granulomatous reaction with macrophage and leukocyte infiltration in the urothelium and lamina propria of the urinary bladder. The local inflammatory effects are associated with an elimination or reduction of non-muscle invasive cancerous lesions of the urinary bladder. The exact mechanism of action is unknown, but the anti-tumour effect appears to be T-lymphocyte dependent. →其治療機轉可能是經由BCG刺激免疫系統活躍進而攻擊癌細胞的免疫反應 Contraindications  ? Bacillus of Calmette and Guerin Vaccine, Live1)? immunocompromised status 2)? urinary tract infection or hematuria 3)? acute febrile illness 4)? 7 to 14 days following biopsy, transurethral resection, or traumatic catheterization; increased risk for systemic BCG infection 5)? active tuberculosis 6)? hypersensitivity to BCG products DOSAGE AND ADMINISTRATION 經膀胱內投藥治療應在組織切片或經尿道切除術(TUR)後7至14日開始，包括誘導期與維持期 誘導期包括每週經膀胱內灌注一次共6週。暫停6週後，再每週灌注一次為期1至3週 維持期為在誘導治療開始後的第6、12、18、24、30及36個月接受每週一次共1至3週的灌注 Adverse Reaction Question  RIFINAH用於BCG膀胱灌注的感染 1.Rifinah預防性投與的合理性?? 2.如何給予劑量?300mg 150mg 3.注意事項? INTRAVESICAL BACILLUS CALMETTE-GUERIN FOR THETREATMENT OF SUPERFICIAL BLADDER CANCER IN RENALTRANSPLANT PATIENTS INTRAVESICAL BACILLUS CALMETTE-GUERIN FOR THETREATMENT OF S