Chinese Journal of Antituberculosis ›› 2019, Vol. 41 ›› Issue (6): 591-603.doi: 10.3969/j.issn.1000-6621.2019.06.003
Special Issue: 标准、共识、指南
• Expert Consensus • Previous Articles Next Articles
Board of Chinese Journal of Antituberculosis Editorial
Received:
2019-05-02
Online:
2019-06-10
Published:
2019-06-04
Board of Chinese Journal of Antituberculosis Editorial. Expert consensus on the solutions of drug side effects during the treatment of drug resistance tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(6): 591-603. doi: 10.3969/j.issn.1000-6621.2019.06.003
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URL: http://www.zgflzz.cn/EN/10.3969/j.issn.1000-6621.2019.06.003
组别 | 药物名称(缩略词) |
---|---|
1.一线口服类抗结核药物 | 异烟肼(H);利福平(R);乙胺丁醇(E);吡嗪酰胺(Z);利福布汀(Rfb);利福喷丁(Rpt) |
2.注射类抗结核药物 | 链霉素(S);卡那霉素(Km);阿米卡星(Am);卷曲霉素(Cm) |
3.氟喹诺酮类药物 | 左氧氟沙星(Lfx);莫西沙星(Mfx);加替沙星(Gfx) |
4.二线口服类抗结核药物 | 乙硫异烟胺(Eto);丙硫异烟胺(Pto);环丝氨酸(Cs); 特立齐酮(Trd);对氨基水杨酸(PAS);对氨基水杨酸-异烟肼(Pa) |
5.其他类抗结核药物 | 贝达喹啉(Bdq);德拉马尼(Dlm);利奈唑胺(Lzd); 氯法齐明(Cfz);阿莫西林-克拉维酸(Amx-Clv);亚胺培南-西司他丁(Ipm-Cln);美罗培南(Mpm); 氨硫脲(Thz);克拉霉素(Clr) |
组别 | 药物名称(缩略词) |
---|---|
A组:氟喹诺酮类药物 | 左氧氟沙星(Lfx);莫西沙星(Mfx);加替沙星(Gfx) |
B组:二线注射类药物 | 阿米卡星(Am);卷曲霉素(Cm);卡那霉素(Km);链霉素(S) |
C组:其他核心二线药物 | 乙硫异烟胺或丙硫异烟胺(Eto或Pto);环丝氨酸-特立齐酮(Cs-Trd);利奈唑胺(Lzd);氯法齐明(Cfz) |
D组:其他药物(非MDR核心药物) | |
D1 | 吡嗪酰胺(Z);乙胺丁醇(E);高剂量异烟肼(Hh) |
D2 | 贝达喹啉(Bdq);德拉马尼(Dlm) |
D3 | 对氨基水杨酸(PAS);亚胺培南-西司他丁(Ipm-Cln);美罗培南(Mpm);阿莫西林-克拉维酸钾(Amx-Clv);氨硫脲a(Thz) |
监测项目 | 监测频率 |
---|---|
血常规(血红蛋白、血小板、白细胞)a | 一般每月检测1次。使用利奈唑胺者开始时每周检测1次,以后每月检测1次,或根据症状调整检测频率 |
肝功能(天冬氨酸氨基转移酶、丙氨酸氨基转移酶)a | 长期接受吡嗪酰胺治疗或有肝损伤高危因素和(或)有肝炎症状者,每2~4周检测1次;并发HIV感染者,建议每2周1次;接受贝达喹啉治疗者每2~4周检测1次;并发病毒性肝炎者,第1个月每1~2周检测1次,以后每1~4周检测1次 |
血肌酐与血清钾a | 接受注射类抗结核药物治疗时,每月检测1~2次;并发HIV感染、糖尿病及其他高危患者每1~3周检测1次 |
血清镁和钙离子 | 出现低钾血症时,应注意同时检测血清镁和钙离子水平;如果使用贝达喹啉建议每2~4周检测1次;如果出现心电图异常(Q-T间期延长)者,应及时进行复查 |
血糖a | 使用加替沙星治疗者,治疗前快速检测血糖,以后每月检测1~2次 |
促甲状腺激素(TSH) | 乙硫异烟胺、丙硫异烟胺和对氨基水杨酸同时使用时,每3个月检测1次;单独使用时,每6个月检测1次;对于临床上有甲状腺功能减退症状和(或)体征者每月检测1次 |
脂肪酶 | 使用利奈唑胺、贝达喹啉而出现腹痛者,为排除胰腺炎时应该进行检测;使用贝达喹啉者建议治疗前进行检测 |
乳酸 | 使用利奈唑胺或抗逆转录病毒药物治疗(ART)者出现乳酸性酸中毒症状时应该进行检测 |
听力测定a | 接受注射类抗结核药物者,治疗前及开始治疗后每月检测1次;每次访视注意询问患者有无听力改变,判断他们是否能够完成正常对话 |
视力测定a | 需长时间使用乙胺丁醇或利奈唑胺的患者,建议治疗前进行视力测定;视力或辨色能力发生可疑变化时,要进行重复检测 |
心电图a | 使用贝达喹啉者于治疗开始前即进行检查,以后在治疗第2、4、8、12周分别进行1次复查;并发心脏功能、甲状腺功能减退或发生电解质紊乱者,应增加检测频率 |
心理咨询a | 治疗前即可进行,治疗中需要按照患者病情随时进行;必要时可向心理医师咨询 |
不良反应类别 | 常用辅助治疗药物 |
---|---|
恶心、呕吐、胃部不适 | 胃复安、多潘立酮、苯海拉明、奋乃静、异丙嗪、恩丹西酮,以及其他5-羟色胺3(5-HT3)受体拮抗剂 |
胸口灼热、反酸和消化不良 | 组胺2受体(H2受体)阻滞剂(雷尼替丁、西米替丁、法莫替丁等),质子泵抑制剂(奥美拉唑、兰索拉唑等)。抑酸剂可降低氟喹诺酮类药物的吸收,若化疗方案中含氟喹诺酮类药物应避免使用 |
腹泻 | 洛派丁胺、益生菌 |
口腔念珠菌病 | 制霉菌素混悬液局部涂抹,或口服氟康唑、伊曲康唑、泊沙康唑等抗真菌药物 |
抑郁症 | 选择性5-HT重摄取抑制剂(氟西汀、舍曲林),三环类抗抑郁药(阿米替林) |
严重焦虑 | 氯羟安定、安定 |
失眠症 | 茶苯海明 |
精神错乱 | 氟哌啶醇、氯丙嗪、利培酮(也包括苯托品或比哌立登阻止椎体外束反应) |
癫痫 | 苯妥英钠、卡马西平、丙戊酸钠、苯巴比妥 |
预防环丝氨酸和异烟肼所致的精神和神经性并发症 | 吡哆醇(维生素B6) |
周围神经病变 | 阿米替林、加巴喷丁 |
前庭症状 | 氯苯甲嗪、晕海宁、奋乃静、盐酸异丙嗪 |
肌肉、骨骼痛,关节疼痛,头痛 | 布洛芬、对乙酰氨基酚、可待因 |
皮肤不良反应,瘙痒 | 氢化可的松乳膏、炉甘石洗剂 |
系统性超敏反应 | 抗组胺药(苯海拉明、氯苯吡胺、晕海宁)及皮质类固醇(强的松、泼尼松龙、地塞米松) |
支气管痉挛 | 吸入性β受体阻滞剂(沙丁胺醇等),吸入皮质类固醇(倍氯米松等),口服糖皮质激素(强的松、泼尼松龙),注射类固醇药物(地塞米松、甲强龙) |
甲状腺功能减退 | 口服左旋甲状腺素 |
电解质降低 | 根据检测结果补充钾、镁、钙(以口服或静脉用药形式) |
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