抗结核病药抗麻风病药

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1、第43章抗结核病药抗麻风病药Anti-tuberculosisandanti-leprosydrugs1【目的要求】1、掌握抗结核病药异烟肼、利福平、乙胺丁醇、对氨水杨酸、链霉素的抗结核作用特点、用途和不良反应；2、掌握抗结核药的用药原则。3、了解砜类抗麻风药。2结核结核俗称“痨病”，它和人类的历史几乎一样长。它曾在全世界广泛流行，夺去了数亿人的生命，人们称之为白色瘟疫。结核病是由结核杆菌引起的慢性传染病，可累及全身多个器官，但以肺结核最为常见。结核病临床上多呈慢性过程，少数可急起发病。常有低热、乏力等全身症状和咳嗽、咯血等呼吸系统表现。3第一节第1线抗结核病药F

2、irst-lineanti-TBdrugs我国现有结核病人600万左右；每年死亡人数25万左右；WHO估计全球每年发病人数约800万人；特别是HIV高发地区TB发病率高。4“制止结核病”世界行动组织公布的数字显示，目前全球每天仍有五千人死于结核病，而每年患结核病的人数超过八百万。一个重要的原因是结核菌逐步发展出来的多种药物抗药性（MDR-TB）有使目前的抗结核菌药物失效的危险。产生抗药性的主要原因和产生抗生素的抗药性类似。目前的抗结核药物通常都需要连续服用六到八个月，而许多患者都不能完成整个疗程，使病菌在低剂量的药物处理下把抗药性的剑越磨越利。5ChestX-ra

3、yofapersonwithadvancedtuberculosis6TuberculosisTuberculosis,MTB,orTB(shortfortuberclebacillus)isacommon,andinmanycaseslethal,infectiousdiseasecausedbyvariousstrainsofmycobacteria,usuallyMycobacteriumtuberculosis.Tuberculosisusuallyattacksthelungsbutcanalsoaffectotherpartsofthebody.Iti

4、sspreadthroughtheairwhenpeoplewhohaveanactiveMTBinfectioncough,sneeze,orotherwisetransmittheirsalivathroughtheair.Mostinfectionsinhumansresultinanasymptomatic,latentinfection,andaboutoneintenlatentinfectionseventuallyprogressestoactivedisease,which,ifleftuntreated,killsmorethan50%ofth

5、oseinfected.7TuberculosisTheclassicsymptomsareachroniccoughwithblood-tingedsputum,fever,nightsweats,andweightloss.Infectionofotherorganscausesawiderangeofsymptoms.Diagnosisreliesonradiology(commonlychestX-rays),atuberculinskintest,bloodtests,aswellasmicroscopicexaminationandmicrobiolo

6、gicalcultureofbodilyfluids.Antibioticresistanceisagrowingproblemin(extensively)multi-drug-resistanttuberculosis.Preventionreliesonscreeningprogramsandvaccination,usuallywithBacillusCalmette-Guérinvaccine.8TuberculosisIn2007therewereanestimated13.7millionchronicactivecases,9.3millionne

7、wcases,and1.8milliondeaths,mostlyindevelopingcountries.Inaddition,morepeopleinthedevelopedworldcontracttuberculosisbecausetheirimmunesystemsaremorelikelytobecompromisedduetohigherexposuretoimmunosuppressivedrugs,substanceabuse,orAIDS.Thedistributionoftuberculosisisnotuniformacrosstheg

8、lobe;