[EFFERENT THERAPY IN THE TREATMENT OF PATIENTS WITH DRUG-RESISTANT PULMONARY TUBERCULOSIS].

Abstract

The study was undertaken to enhance the efficiency of therapy in patients with drug-resistant pulmonary tuberculosis, by correcting homeostasis by efferent therapy. The results of examination and treatment were analyzed in 140 patients aged 18 to 65 years with destructive pulmonary tuberculosis treated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. According to the treatment modality, the patients were divided into 2 groups: 1) 73 patients in whom therapeutic plasmapheresis was used as efferent therapy to treat drug intolerance and endotoxicosis (a study group); 2) 67 patients who had no therapeutic plasmapheresis (a control group). The use of small-volume plasmapheresis in patients with drug-intolerance destructive pulmonary tuberculosis favored a rapid and prolonged hepatic function recovery in 100% of cases, which made it possible to continue antituberculous therapy (ATT) and to determine a good treatment outcome as a whole. When toxic and allergic reactions to antituberculous drugs occurred in patients with drug-resistant fibrocavernous tuberculosis during treatment, the use of efferent detoxification techniques yielded a significant correcting effect, halved the duration of ATT discontinuation, and indirectly contributed to a 2.5-fold reduction in the level of bacterial excretion in the study group patients as compared with the controls (49.3% versus 19.4%). Furthermore, pulmonary infiltrate resolution was twice more frequently observed in the patients receiving plasmapheresis during etiotropic therapy than that in the controls (50.7% versus 28.4%).