결핵 진료지침 권고 요약(개정판) Ⅱ. 결핵의 치료 2. 결핵의 치료원칙
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작성자 김병광 작성일 16-09-25 10:44 조회 3,528 댓글 1본문
Ⅱ. 결핵의 치료
2. 결핵의 치료원칙
⑴ 내성발현을 예방하기 위해서 적어도 3가지 이상의 여러 항결핵제의
병합요법이 필요합니다.
⑵ 충분한 항결핵 효과를 얻기 위하여 정확한 용량으로 항결핵제들을 처방해야
하며, 일차 항결핵제의 경우 최고 혈중농도가 중요하므로 1일 1회 복용해야
합니다.
⑶ 환자는 처방된 항결핵제들을 규칙적으로 6개월 이상 장기간 복용하여야
합니다.
☎ 병합요법을 사용하는 이유
- 한 가지 약제에 내성이 보이더라도 다른 약제는 효과가 있으므로 치료될
수 있습니다.
- 인체 내에서 결핵균이 증식하는 형태와 각각의 항결핵제의 특이적 작용기전
에 근거합니다.
결핵균이 산소분압이 높은 세포 밖에서 신속히 증식하는 결핵균은
살균능력이 높은 이소니아지드가 효과적이며 질환초기의 감염력을
감소시키며 내성발현을 억제하고
결핵균이 천천히 증식하는 산소분압이 낮은 세포내에서는 피라진아마이드
가,
섬유화병변에서는 리팜핀이 가장 효과적입니다.
- 그러므로 서로 다른 기전으로 작용하는 항결핵제들을 병합하면 초기에
신속히 결핵균을 제거하고, 내성발생을 예방하며, 재발의 위험을 감소하는
효과를 기대할 수 있습니다.
- 결핵균은 증식이 느리고 일부는 간헐적으로 증식하기도 합니다.
항결핵균제는 결핵균의 대사과정에 관여하여 항균효과를 나타내므로
증식하지 않는 결핵균에는 효과가 없습니다. 그러므로 간헐적으로 증식하는
균까지 모두 살균하기 위해서는 6개월 이상 장기간 치료가 필요합니다.
- 결핵병소에 소수의 결핵균은 휴지기 상태에 있을 수 있으므로 이들은
항결핵제에 듣지 않습니다. 그러므로 결핵을 종결하고 오랜 기간이 지난
뒤에 휴지기 상태에 있던 결핵균이 재활성화되어 결핵균이 재발할 수
있습니다.
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