BACKGROUND/AIMS: The aim of this study was to determine the actual practice patterns of clinicians caring for Korean patients with inflammatory bowel diseases (IBDs). METHODS: Questionnaires, including te indications and doses of 5-aminosalicylic acid (5-ASA), corticosteroids, or azathioprine/6-mercaptopurine (AZA/6-MP), assessment of response, the surveillance method, and the interval for adverse effects, were distributed during the 2008 KASID annual lecture. Thirty questionnaires were collected. RESULTS: Most of the responders (93.3%) were board-certified with sub-specialty training in gastroenterology. For active diseases, 43.3% of the responders escalated the dose of 5-ASA from conventional to maximal doses. Of the patients in disease remission, 36.7% were maintained on the conventional or a reduced dose for a fixed period of time. Corticosteroids were prescribed by dose-base (20/30 [66.7%]). In most cases, the starting dose was 40 mg/d (15/19 [78.9%]), and tapered within a 1 (43.3%) or 2 week interval (40.0%). There were various definitions of corticosteroid-refractoriness and -dependency among the responders. Most of the responders initiated AZA at 50 mg/d; 68.4% of the patients increased the dose by 25 mg and 55.6% of the patients increased the dose within a 4-week interval. For monitoring adverse events, such as leukopenia, 63.3% of the patients checked a complete blood count for 2 weeks in the 1st month of therapy. CONCLUSIONS: There were various patterns of practice in the treatment of Korean IBD patients, especially in terms of the prescribing patterns of drugs and assessment of response, which suggests that standard therapeutic guidelines of IBD should be established in Korea.
Adrenal Cortex Hormones ; Aminosalicylic Acids ; Azathioprine ; Blood Cell Count ; Gastroenterology ; Glucocorticoids ; Humans ; Inflammatory Bowel Diseases ; Korea ; Leukopenia ; Mesalamine ; Physician's Practice Patterns ; Surveys and Questionnaires

Pancreatitis has been occasionally associated with Crohn's disease (CD). A definite etiology of pancreatitis can be identified in most patients, but a very small proportion remain idiopathic. We report a case of idiopathic pancreatitis resolved along with the clinical improvement of CD in a 25-year-old man. He presented with abdominal pain and diarrhea for 8 years. Ileocolonoscopy and enteroclysis showed multiple, longitudinal ulcers and strictures at the ileojejunum. The laboratory findings showed elevated serum amylase (951 IU/L) and lipase (326 IU/L) without positive autoantibodies. Esophagogastroduodenoscopy, enhanced pancreatic CT, and MRCP showed no abnormalities at ampulla of Vater, pancrease, and pancreaticobiliary duct. With the treatment with antibiotics, 5-aminosalicylic acid, steroid, and azathioprine, as a whole, decreasing pattern and intermittent fine coordinated fluctuation of the levels of amylase and lipase along with the decrease of Crohn's disease activity index (CDAI) and the CRP levels were observed. Then, three months after the start of the treatment, normalization of the pancreatic enzymes was observed, and there was recurrent elevation of pancreatic engyme during 12 months maintenance therapy. This report supports the concept of an association between idiopathic pancreatitis and CD, based on a significant and close relation between the levels of serum amylase and lipase, and CDAI.
Adult ; Aminosalicylic Acids/therapeutic use ; Amylases/blood ; Crohn Disease/complications/*diagnosis ; Diagnosis, Differential ; Duodenoscopy ; Humans ; Lipase/blood ; Male ; Pancreatitis/*diagnosis/enzymology/etiology ; Tomography, X-Ray Computed

No abstract available.
Aminosalicylic Acid* ; Cycloserine* ; Prothionamide* ; Retreatment* ; Tuberculosis, Pulmonary*

Hypersensitivity reactions against para-aminos alicylic have been recorded infrequently in the literature. It is the purpose of this report to emphasize the possible occurence of severe reactions which may result in death if unrecognized. The recognition of the early signs and symptoms of a hypersensitivity reaction to antituberculous drugs is all important because serious consequences can ensue from continued administration of the drug after the first sign of a reaction. This case present acute liver failure as part of a generalized hypersensititivity reaction to para-aminosalicylic acid, based on clinical findings liver function test, course and response to cortison derivatives.
Aminosalicylic Acid ; Hypersensitivity ; Liver Failure, Acute ; Liver Function Tests

Adult ; Aminosalicylic Acid ; therapeutic use ; Female ; Humans ; Manganese Poisoning ; drug therapy

BACKGROUND: Tuberculosis is still one of the most seriously threatening infections in Korea, because of multidrug resistant tuberculosis. Results of antituberculosis drug susceptibility test can provide clinicians very important informations for selection of proper regimens for treatment. METHODS: In this study the results of antituberculosis drug susceptibility test of 298 cases at Kyunghee Medical Center from 2000 to 2003 were retrospectively analysed to evaluate the trend of antituberculosis drug susceptibility. The procedure of drug susceptibility test was based on the absolute concentration method using Lowenstein-Jensen solid media. RESULTS: The resistance rate of Mycobacterium tuberculosis to one or more drugs was increased from 29.3% in 2000 to 48.2% in 2003, and the rates of multiple resistance to two or more drugs increased from 13.3% in 2000 to 20.5% in 2003. The increase in resistance rate to individual drug during study period were 20.0% to 24.1% in isoniazid, 9.3% to 19.3% in rifampicin, 5.3% to 15.7% in ethambutol, 4.0% to 10.8% in para-aminosalicylic acid, 2.7% to 6.0% in kanamycin, 1.3% to 7.2% in ethionamide, 1.3% to 6.0% in capreomycin, 1.3% to 7.2% in prothionamide, 0.0% to 12.1% in ofloxacin, 6.7%to 3.6% in streptomycin, 6.7% to 7.2% in cycloserine, 10.7% to 8.4% in pyrazinamide, respectively. CONCLUSIONS: The resistance rate of M. tuberculosis has been increased with years and multidrug resistant M. tuberculosis was commonly encountered in the specimens from the patients visited Kyunghee Medical center.
Aminosalicylic Acid ; Capreomycin ; Cycloserine ; Ethambutol ; Ethionamide ; Humans ; Isoniazid ; Kanamycin ; Korea ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Pyrazinamide ; Retrospective Studies ; Rifampin ; Streptomycin ; Tuberculosis

BACKGROUND: The purposes of the current study were to evaluate the concordant rates of anti-mycobacterial drug susceptibility test (DST) results in different solid media performed in different institutes, and to determine reliable susceptible testing methods. METHODS: One hundred and twenty two Mycobacterium tuberculosis strains were isolated from patients in A Hospital in 2005. DSTs were performed by the absolute concentration method using L?wenstein Jensen medium in both A Hospital (method A-1) and B Institute (method B-1) and by the proportion method using Middlebrook 7H10 agar in B Institute (method B-2). Nine drugs were used including isoniazid and rifampin. Sensitivity and specificity of each method were estimated by using the acceptable standard of 90% for isoniazid and rifampin and 80% for other drugs. The therapeutic outcomes of quinolone-administered patients were evaluated according to ofloxacin susceptibility results. RESULTS: Method B-1 showed sensitivity and specificity levels over the acceptable standard levels for all drugs. Method B-2 showed specificity lower than the acceptable levels for rifampin and cycloserine. Method A-1 showed specificity lower than the acceptable levels for isoniazid, streptomycin, p-aminosalicylic acid, and ofloxacin and sensitivity lower than the acceptable levels for prothionamide and cycloserine. The concordance rates of therapeutic outcomes with method B-1, method B-2, and method A-1 were 77%, 74%, and 65%, respectively. CONCLUSION: The drug susceptibility results for some drugs were discordant between the testing laboratories and media, requiring an urgent application of quality control programs to raise the reliability of anti-mycobacterial DST.
Academies and Institutes ; Agar ; Aminosalicylic Acid ; Culture Media ; Cycloserine ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Quality Control ; Rifampin ; Sensitivity and Specificity ; Streptomycin

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome.
Adult ; Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol ; Female ; Fever ; Humans ; Hypersensitivity ; Isoniazid ; Kanamycin ; Leukocytosis ; Levofloxacin ; Patch Tests ; Prednisolone ; Pyrazinamide ; Rifampin ; Tuberculosis

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Desensitization, Immunologic ; Drug Hypersensitivity Syndrome* ; Hepatic Encephalopathy ; Humans ; Hypersensitivity ; Kanamycin ; Levofloxacin ; Male ; Methylprednisolone ; Middle Aged ; Patient Dropouts ; Pyrazinamide ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

PURPOSE: The rate of drug-resistant tuberculosis (DR-TB) in children is an indicator of the effectiveness of TB control programs in the community. This study aimed to assess the prevalence of DR-TB in children and evaluate TB management. METHODS: Between January 1999 and July 2007, drug susceptibility tests for anti-TB drugs were employed for patients aged less than 19 years with culture-positive TB. RESULTS: A total of 607 cases (16.6%) were resistant to at least one anti-TB drug as follows: isoniazid (INH; 13.8%), rifampin (8.9%), pyrazinamide (4.2%), streptomycin (3.7%), ethambutol (EMB; 5.9%), and para-aminosalicylic acid (PAS; 1.9%). Multidrug-resistant (MDR) TB was found in 276 cases (7.6%); extensive drug resistant (XDR) TB, in 5 case s (0.2%). The rate of resistance to at least one anti-TB drug in children aged >15 years (16.1%) was significantly lower than that in children aged <15 years (20.5%) (P=0.016). The rate of resistance to at least one anti-TB drug and multidrug-resistance in this survey decreased significantly (P<0.001) as compared to the previous survey (1987-1995). The rate of resistance to INH, EMB, and PAS also significantly decreased (P<0.05 ). CONCLUSION: The rate of DR-TB in children in Korea has decreased over time; however, it remains higher than that in other countries. MDR-TB and XDR-TB are the emerging problems in Korean children. Therefore, the selection of effective drugs through drug susceptibility tests and evaluating risk factors of resistant TB is essential to successful therapy and a decreased incidence of DR-TB.
Aged ; Aminosalicylic Acid ; Child ; Drug Resistance ; Ethambutol ; Extensively Drug-Resistant Tuberculosis ; Humans ; Incidence ; Isoniazid ; Korea ; Mycobacterium ; Mycobacterium tuberculosis ; Prevalence ; Pyrazinamide ; Rifampin ; Risk Factors ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant