7/24/2019 Tb for Extern

1/5

INH RMPEMB metabolites PZA

creatinine clearance < 30 (concentration dependent bactericidal)

SM INH 6 (pyridoxine)50100

(hemodialysis) PZA

hemodialysisE,Z 3 / CrCl 3

2 2 SHRE / 7HR

9 HRE

6-9 RZE

1 2 SHE/16 HE

18-24 HE + Fluoroquinolone

INH 6 (pyridoxine)50100

INH, R, Z pattern of liver injury Hepatitis Non-imunemediated (non-allergic)

7/24/2019 Tb for Extern

2/5

**

2 (major side-effects) (minor side-effects)

7/24/2019 Tb for Extern

3/5

Antihistamine Maculopapular rash Antihistamoine

prednisolone low dose

systemic steroid prednisolone 40-60

- H R E Z - 1/3 1/2 2-3

/

. H, R Zbilirubin AST/ALT R

7/24/2019 Tb for Extern

4/5

AST/ALT total bilirubin (TB)

AST/ALT TB 1-2 1

AST/ALT > 3

H, R Z E, quinolone, streptomycin

AST/ALT < 3

3

TB > 3 ./AST/ALT 3

RAST/ALT < 5

1

AST/ALT > 5 H, R Z E, quinolone, streptomycin

re-challenge

fulminant hepatitis AST/ALT < 2 TB < 1.5 H, R Z 1 re-challenge AST/ALT TB

(Optic neuritis, Retrobulbar neuritis)

ethambutol isoniazid(dyschromatopsia, - -) (central scotoma)

50

7/24/2019 Tb for Extern

5/5

ethambutolethambutol 15 ././20 ././

INH

INH

(kg)

GFR40-50 >50-70*

Isoniazid (H)

(4-8mg/kg/day)

300 300 300

Rifampin (R)

(8-12mg/kg/day)

450 450 600

Pyrazinamide

(Z)

(20-30mg/kg/day)

1000 1250 1500 : 3 Dialysis(WHO 2010: 25mg/kg)

Ethambutol (E)

(15-20mg/kg/day)

600 800 1000 : 3 Dialysis(WHO 2010: 15mg/kg)

Streptomycin

(S)

(15mg/kg/day)

500 750 750-

1000**

12-15mg/kg:2-3 Dialysis(WHO 2010: 15mg/kg)

Nephrotoxicity

Ototoxicity

serum

level streptomycin

* < 35 > 70 kg

**> 60 750 mg/dayReference

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