J Microbiol Immunol Infect2004;37:382-384
Guidelines for chemotherapy of tuberculosis in Taiwan Infectious Diseases Society of the Republic of China; The Society of Tuberculosis, Taiwan;Medical Foundation in Memory of Dr. Deh-Lin Cheng; Foundation of Professor Wei-Chuan Hsieh forInfectious Diseases Research and Education; and CY Lee’s Research Foundation for Pediatric Infectious
Tuberculosis is a major health problem in Taiwan
1. Establishment of guidelines from the viewpoint of
and worldwide. Despite concerted efforts of health
authorities to control tuberculosis, the incidence and
2. Antimicrobial agents recommended in the guidelines
prevalence of tuberculosis in Taiwan remains high
are agents already marketed in Taiwan.
(64.84/100,000 and 5.56/100,000 in 2001). Most cases
3. Guidelines were based on academic principles rather
of tuberculosis are now seen and treated by primary
than the regulations of the Bureau of National Health
A consensus meeting was convened on March 10,
Many recommendations were based on expert
2004 to establish guidelines for the chemotherapy of
opinion and unpublished data, due to the lack of
tuberculosis. This was preceded by a collaborative
randomized, controlled, clinical trials in the area. Topics
symposium on tuberculosis held by the Infectious
not included in the scope of these guidelines are:
Diseases Society of the Republic of China (IDSROC),
treatment of TB-human immunodeficiency virus (HIV)
the Medical Foundation in Memory of Dr. Deh-Lin
coinfection, drug-drug interactions, several anti-
Cheng, Foundation of Professor Wei-Chuan Hsieh
tuberculous drugs (rifabutin, cycloserine) and treatment
for Infectious Diseases Research and Education, and
CY Lee’s Research Foundation for Pediatric Infectious
This guideline was approved by the board of IDSROC,
Diseases and Vaccines. Participants of the consensus
and a copy will be sent to primary care physicians, the
meeting included board members of the IDSROC, and
setting where most cases of tuberculosis are treated. The
experts in infectious diseases, chest medicine, and
document is published in the Journal of Microbiology,
tuberculosis.* Three principles were maintained in
Immunology and Infection, to serve as an easily accessible
reference to all practising physicians in Taiwan.
Guidelines for chemotherapy of tuberculosis
Pulmonary tuberculosis Drugs of choice Alternative I. New case
then INH + RIF + EMB for 4 monthsa
then Rifinahc + EMB for 4 monthsaII. Retreatmentd
INH + RIF + EMB + PZA + IAf for 3 months,
INH + RIF + EMB + PZA + IAf for 3 months,
INH + RIF + EMB + PZA + IAf for 3 months,
III. Drug resistance
RIF + EMB + PZA + IAf for 6 months
INH + EMB + PZA + IAf ± FQifor 9 months
EMB + PZA + TBN + IAf + FQi
PZA + TBN + PAS + IAf + FQiIV. Intolerance
INH + EMB + PZA + IAf for 9 months
EMB + PZA + TBN + IAf + FQiV. Special situations
RIF + EMB + IAf + FQi for 12-18 months
EMB + TBN + IAf + FQi for 18-24 months
INH + RIF + EMBl + PZAl for 2 months,
then INH + RIF + EMBl for 4 months
then INH + RIF + EMB for 4 monthsmExtra-pulmonary tuberculosis Drugs of choice Alternative Dosage of anti-tuberculous agents (for adults only)
Rifater (INH 80 mg + RIF 120 mg + PZA 250 mg )
15-20 mg/kg BW, divided to bid-tid (maximum 1 g)
Abbreviations: INH = isoniazid; RIF = rifampin; EMB = ethambutol; PZA = pyrazinamide; IA = injectable aminoglycosides; FQ =
fluoroquinolones; MDR-TB = multi-drug resistant Mycobacterium tuberculosis; TBN = prothionamide; PAS = para-aminosalicylic acid;
ESRD = end-stage renal disease; CNS = central nervous system; BW = body weight; qd = once daily; bid = twice a day; tiw = 3 times
weekly; tid = 3 times a day; qid = 4 times a day; qod = once every other day; tab = tablet(s); Ccr = creatinine clearance
aCavitation on initial chest X-ray and/or positive cultures at completion of initial 2 months’ treatment, extend treatment to 9 months. bDose of Rifater is 1 tab/10 kg BW qd, maximum 5 tab. cDose of Rifinah-300 is 2 tab qd for patients with BW >50 kg, and Rifinah-150 3 tab qd if BW <50 kg. dCulture and susceptibility testing should be done immediately and regimen should be tailored to susceptibility testing results. Referral
to specialists in infectious diseases, chest medicine or experts on tuberculosis is recommended. eRelapse is defined as a patient who develops active tuberculosis (by culture, clinical or radiological deterioration) after completion of
fInjectable aminoglycosides include streptomycin, kanamycin, and amikacin, and should be administered in the initial 2 months of
gDefault is defined as interruptions in therapy of longer than 2 months. hFailure is defined as continued or recurrent positive cultures after 4 months of treatment in patients with assured adherence to the
prescribed anti-tuberculous regimen. iFluoroquinolones include ofloxacin, ciprofloxacin and levofloxacin. jTreatment duration is a total of 18 months after sputum conversion. kRenal function impairment is defined as Ccr ≤30 mL/min. lDoses should be reduced to EMB 15-25 mg/kg BW qod and PZA 12-25 mg/kg BW qd. mIntermittent (3 times weekly) dosing after hemodialysis is INH 900 mg, RIF 600 mg, EMB 15-25 mg/kg BW and PZA 25-35 mg/kg BW. nSteroids are recommended (prednisolone <1 mg/kg BW qd or equivalent) for a minimum of 3 weeks. • Consensus Conference Participants (in alphabetical order): Feng-Yee Chang, Shan-Chwen Chang, Yao-Shen Chen, Yee-Chun Chen, Chen-Yuan Chiang, I-Hsin Chiang, Ming-Yuan Chou, Mong-Ling Chu, Yin-Ching Chuang, Szu-Min Hsieh, Wei-Chuan Hsieh, Po-Ren Hsueh, Bor-Shen Hu, Fu-Yuan Huang, Li-Min Huang, Kun-Yen Huang, Kao-Pin Hwang, Chi-Kin Lan, Yeu-Jun Lau, Chin-Yun Lee, Chun-Ming Lee, Susan Shin-Jung Lee, Hsieh-Shong Leu, Tzou-Yien Lin, Cheng-Yi Liu, Ching-Chuan Liu, Yung-Ching Liu, Kwen-Tay Luh, Jen Suo, Hung-Chin Tsai, Lih-Shinn Wang, Shue-Ren Wann, Wing-Wai Wong, Yi-Chun Wu, Muh-Yong Yen
Pharmaceuticals and Personal Care Products For the Wastewater Treatment Community The National Association of Clean Water Agencies New chemical detection methods and a greater focus on water quality monitoring have generated a significant interest in the pharmaceuticals, personal care products (PPCPs), and other compounds that are making their way into the nation’s rivers, streams, lake
MATH 2300 – review problems for Exam 1 ANSWERSsin x cos x dx in each of the following ways: This one is self-explanatory; we(a) Integrate by parts, with u = sin x and dv = cos x dx. The integral you get on the right shouldlook much like the one you started with, so you can solve for this integral. (b) Integrate by parts, with u = cos x and dv = sin x dx. (e) First use the fact that sin x co