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심태선 대한장연구학회 2014 Intestinal Research Vol.12 No.1
Patients with intractable inflammatory bowel diseases (IBD) are increasingly being treated with anti-tumor necrosis factor (TNF) agents and are at increased risk of developing tuberculosis (TB). Therefore, diagnosis and treatment of latent TB infection (LTBI) is recommended in patients due to the initiation of anti-TNF therapy. Traditionally, LTBI has been diagnosed on the basis of clinical factors and a tuberculin skin test. Recently, interferon-gamma releasing assays (IGRAs) that can detect TB infection have become available. Considering the high-risk of developing TB in patients on anti-TNF therapy, the use of both a tuberculin skin test and an IGRA should be considered to detect and treat LTBI in patients with IBD due to the initiation of anti-TNF therapy. The traditional LTBI treatment regimen has consisted of isoniazid monotherapy for 9 months. However, shorter regimens such as 4 months of rifampicin or 3 months of isoniazid/rifampicin have been used increasingly to improve treatment completion rates. In this review, the incidence of TB and the prevalence of LTBI in patients with IBD will be briefly described, as well as methods for diagnosing latent and active TB before anti-TNF therapy, current LTBI treatment regimens, recommendations for managing TB that develops during anti-TNF therapy, the necessity of regular monitoring to detect new TB infection, and the re-initiation of anti-TNF therapy in patients who develop TB.
Medical Treatment of Pulmonary Multidrug-Resistant Tuberculosis
심태선,조경욱 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.4
Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the high toxicity of second-line drugs and thelonger treatment duration required compared with drug-susceptible TB. The efficacy of treatment for MDR-TB is poorer thanthat for drug-susceptible TB. The selection of drugs in MDR-TB is based on previous treatment history, drug susceptibility results,and TB drug resistance patterns in the each region. Recent World Health Organization guidelines recommend the use of least 4second-line drugs (a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid)in addition to pyrazinamide. The kanamycin is the initial choice of injectable durgs, and newer fluoroquinolones include levofloxacinand moxifloxacin. For MDR-TB, especially cases that are extensively drug-resistant, group 5 drugs such as linezolid,clofazimine, and amoxicillin/clavulanate need to be included. New agents with novel mechanisms of action that can be givenfor shorter durations (9-12 months) for MDR-TB are under investigation.