UPDATE Diagnosis and Treatment of 结核的诊断与治疗的更新课件.pptVIP

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UPDATE Diagnosis and Treatment of 结核的诊断与治疗的更新课件.ppt

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UPDATE Diagnosis and Treatment of 结核的诊断与治疗的更新课件

* * * * * * For RIF 3 were drop out (2 lost of FU, 1 refused TX), 2 had side effects (2 other than hepatitis). For INH, 7 were drop out (2 lost of FU, 3 no compliance, 1 other medical problem, 1 refused to continue therapy), 6 had side effects (4 were hepatitis, 2 others) Experimental Study of Short-Course Preventive Therapy in Mice – the start of 2RIF-PZA Lecour HF, et.al. Am Rev Respir Dis 1989:140:1189-93 International Study of 12INH vs 2RIF-PZA in HIV Infected patients - OUTCOMES Regimen 2 RIF/PZA 12 INH RR (CI) No. enrolled 791 790 Confirmed TB 19 26 0.7 (.4,1.2) Conf/Probable TB 28 29 0.95 (.6,1.2) Death 139 159 0.9 (.7,1.1) Completion of therapy – 6 INH vs 2RZ(From Gao et al, IJTLD; 2006:10:1080-1090) Author Location 6 INH 2 RZ Halsey Haiti 55% 74% Mwinga Zambia 66% 75% Jasmer USA 57% 61% Leung Hong Kong 89% 83% Tortajada Spain 77% 82% Serious Adverse Events – 6INH vs 2RZ(From Gao et al, IJTLD; 2006:10:1080-1090) Author Mean Age 6-12 INH 2 RZ Halsey 31 0 0 Mwinga 31 3% 4% Jasmer 37 3% 9% Leung 60 6% 35% Tortajada nr 4% 12% 2 months Rifampin and PZA In 1989 – 2 mos RIFPZA – effective in mice 1990-2000 – several trials – all in HIV infected 2000 – Strong recommendations – to use this 2000-2001 – Reports of severe hepatitis 2001 – recommendation withdrawn DO NOT USE 2 RIF-PZA LTBI treatment – what are the options? 6-9 months of INH 2 months RIF-PZA 3-4 months INH-RIF 3 months once weekly INH Rifapentine 4 months RIFampin 3-4 mos Rifampin-INH vs 6-12 mos INH A meta-analysis of 5 RCT’s Occurrence of active TB(Ena Valls, Clin Inf Dis; 2005; 40: 670-676) (+0.1%) 41/972 39/954 Pooled estimates (+0.3%) 9/556 7/536 Whalen (Uganda – HIV) (+0.1%) 3/82 3/83 Rivero (Spain – HIV) (- 3.3%) 2/69 4/64 Martinez (Spain - HIV) (+1.0%) 1/98 0/98 Martinez (Spain – HIV) (+1.1%) 26/1