腹部結核を伴う重症患者における抗結核療法の調整
Rajangam Hariharan1, Hisham Basheer1, Natarajan Kandaswamy2
1Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, Puducherry, India.
BMJ case reports
|February 24, 2026
まとめ
腹部結核による腸管穿孔は集中治療を必要とする。静脈内抗結核療法は、重症患者の吸収と転帰を改善し、完全回復のための経口治療への移行を橋渡しした。
科学分野:
- 消化器病学
- 感染症
- 集中治療医学
背景:
- 腹部結核は、腹膜炎や腸管穿孔などの急性外科的緊急事態を呈することがある。
- 標準的な経口抗結核療法は、結核菌が感受性であっても、消化管吸収不良や薬物動態の変化により、重症患者では効果がない場合がある。
主な方法:
- 腹部結核および回腸穿孔を有する若い女性が、緊急開腹術および集中治療を受けた。
- 初期治療は、腸管機能が正常化するまで静脈内アミカシン、リネゾリド、レボフロキサシンを含んだ。
- 消化管機能回復後に標準的な経口療法(リファンピシン、イソニアジド、ピラジナミド、エタンブトール)への移行を開始した。
結論:
- 短期間の静脈内抗結核レジメンは、消化管合併症のある重症患者において、重要な橋渡しとして機能することができる。
- 薬物動態学的考慮事項と多職種アプローチは、腹部結核の複雑な症例の管理に不可欠である。
- 経口吸収が信頼できない場合、静脈内抗結核薬の組み合わせは効果的である可能性がある。
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