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1、【分享分享】WHO 提出治疗提出治疗 TB17 个标准个标准 -Standard 1.All persons with otherwise unexplained productive cough lasting twothree weeks or more should be evaluated for tuberculosis.任何人有无法解释的有痰咳嗽超过 2 到 3 星期必须要做结核检查Standard 2.All patients (adults, adolescents, and children who are capable of producing sputum) suspe
2、cted of having pulmonary tuberculosis should have at least two, and preferably three, sputum specimens obtained for microscopic examination. When possible, at least one early morning specimen should be obtained.所以被怀疑有肺结核的人必须至少留两套,最好 3 套的痰液样本供显微镜检,如果可行 的话至少有一套样本要在清晨留检Standard 3. For all patients (adu
3、lts, adolescents, and children) suspected of having extrapulmonary tuberculosis, appropriate specimens from the suspected sites of involvement should be obtained for microscopy and, where facilities and resources are available, for culture and histopathological examination.所有被怀疑有肺外结核的人应取的所怀疑部位的组织样本供
4、显微镜检,甚至是培养病 菌及组织病理学检查Standard 4.All persons with chest radiographic findings suggestive of tuberculosis should have sputum specimens submitted for microbiological examination.所有胸部 X 光显示可能有肺结核的患者都应留痰液样本供微生物检查Standard 5.The diagnosis of sputum smear-negative pulmonary tuberculosis should be based on t
5、he following criteria: at least three negative sputum smears (including at least one early morning specimen); chest radiography findings consistent with tuberculosis; and lack of response to a trial of broad spectrum antimicrobial agents. (NOTE: Because the fluoroquinolones are active against M. tub
6、erculosis complex and, thus, may cause transient improvement in persons with tuberculosis, they should be avoided.) For such patients, if facilities for culture are available, sputum cultures should be obtained. In persons with known or suspected HIV infection, the diagnostic evaluation should be ex
7、pedited.痰液抹片阴性的肺结核诊断准则为:所有痰液抹片(包括至少一套清晨留检的痰液样本)为 阴性,但胸部 X 光持续显示为肺结核.而且肺部病灶对广效性抗生素治疗没有疗效.对于这 样的病患应该给予痰液培养检查.怀疑或是 hiv 带原病患这各诊断流程要快速一点.Standard 6.The diagnosis of intrathoracic (i.e., pulmonary, pleural, and mediastinal or hilar lymph node) tuberculosis in symptomatic children with negative sputum smea
8、rs should be based on the finding of chest radiographic abnormalities consistent with tuberculosis and either a history of exposure to an infectious case or evidence of tuberculosis infection (positive tuberculin skin test or interferon gamma release assay). For such patients, if facilities for cult
9、ure are available, sputum specimens should be obtained (by expectoration, gastric washings, or induced sputum) for culture.在痰液抹片检查为阴性但有症状的小孩若要诊断为胸内结核(也就是肺内,肋膜,中膈腔 或气管的淋巴结)的准则为:胸部 X 光持续显示为结核且与确定结核病 患有接触的病史或其它检查显示有结核感染(阳性的结核菌素皮肤测验或是阳性的干 扰素 gamma 释放测验)对于酱子的病患如果可行的话应予以痰液样本的培养Standard 7.Any practitioner
10、treating a patient for tuberculosis is assuming an important public health responsibility. To fulfill this responsibility the practitioner must not only prescribe an appropriate regimen but, also, be capable of assessing the adherence of the patient to the regimen and addressing poor adherence when
11、it occurs. By so doing, the provider will be able to ensure adherence to the regimen until treatment is completed.所有治疗结核病患的医师应自觉担负着重要的公卫责任.为符合这项责任医师应给予 正确配方之外也应完整评估治疗的持续性,特别注意病患有不遵医嘱的情形.所有医师都应该 确保疗程的完整性.Standard 8.All patients (including those with HIV infection) who have not been treated previously
12、 should receive an internationally accepted first-line treatment regimen using drugs of known bioavailability. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol.The preferred continuation phase consists of isoniazid and rifampicin given for four mo
13、nths. Isoniazid and ethambutol given for six months is an alternative continuation phase regimen that may be used when adherence cannot be assessed, but it is associated with a higher rate of failure and relapse, especially in patients with HIV infection. The doses of antituberculosis drugs used sho
14、uld conform to international recommendations. Fixed-dose combinations of two (isoniazid and rifampicin,three (isoniazid, rifampicin, and pyrazinamide), and four (isoniazid,rifampicin, pyrazinamide, and ethambutol) drugs are highly recommended,especially when medication ingestion is not observed. 所有以
15、前没有治疗过的结核病患(包括 HIV 感染者)应接受国际公认的第一线用药,开 始的治疗必须包含两各月的 isoniazid, rifampicin, pyrazinamide, and ethambutol 药物治疗.接 着是四各月的 isoniazid and rifampicin 药物治疗(如果病患的用药顺从性无法评估也可以给 予六各月 Isoniazid and ethambutol 药物治疗,但是会有较高的治疗失败或复发的机率,尤其是 HIV 感染者更是如此).抗结核药物的剂量应符合国际标准,固定剂量的多重药物治疗 (isoniazid and rifampicin 两种合并,ison
16、iazid, rifampicin, and pyrazinamide 三种合并,以及 isoniazid,rifampicin, pyrazinamide, and ethambutol 四种合并)是被高度建议的,尤其是当病患 用药无法监测时.第一个月第二个月 Isoniazid,rifampicin （initial phase）开始期 pyrazinamide, ethambutol第三个月第六个月 Isoniazid , rifampicin（continuation phase） 后续治疗期 Standard 9.To foster and assess adherence, a patient-centered approach to administration of drug treatment, based on the patients needs an
