medicina46巻4号

2009年04月発行

今月の主題 苦手感染症の克服 免疫不全と感染症

ステロイド長期使用患者での免疫不全と感染症

著者： 大路剛¹ 岸本暢将²

所属機関： ¹亀田総合病院総合診療・感染症科 ²亀田総合病院リウマチ膠原病内科

ページ範囲：P.592 - P.595

ポイント

●ステロイド投与の際は，プレドニゾロン換算15～20 mg／日以上の投与量で，8週間以上投与する場合はPCP予防投与を考慮する．

●PCP予防に，現在日本で使用可能なもので最も効果と副作用のバランスがとれているのはST合剤．

●結核発症リスクは，プレドニゾロン15 mg／日以上で高まる．

●潜在結核が証明できれば治療したほうがよい．

●ステロイド投与下でのイソニアジドによる結核の発症予防のRCTは存在しないが，有用性を示唆するstudyは散見される

●B型肝炎合併症例では，肝臓内科と相談すべきである．

参考文献

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