Acute pulmonary tuberculosis in East Africans: A controlled trial of isoniazid in combination with streptomycin or PAS

Abstract

Summary Sixty-five East Africans with acute bilateral pulmonary tuberculosis, bacteriologically positive, were treated either with streptomycin 1 g. plus isoniazid 200 mg. daily (33 SH patients) or with PAS sodium 20 g. plus isoniazid 200 mg. daily (32 PH patients) for a period of twelve weeks, the treatments being allocated at random. The majority of patients in each treatment series continued on the same combination for a second twelve weeks, though in the SH series the dosage of both drugs was reduced. At the start of the trial there were more very ill patients in the SH than in the PH series. No troublesome toxic effects from any of the drugs were encountered. Nearly all the patients in both series improved clinically and bacteriologically. Thus at the end of twenty-four weeks, 93 per cent of the SH patients and 87 per cent of the PH patients showed radiographic improvement, and only 3 patients (2 SH, 1 PH) still had a positive sputum. At the end of twelve weeks the SH combination was slightly superior to the PH combination in respect of weight gain and radiographic changes; at the end of twenty-four weeks, the differences between the two regimes were smaller. In the whole twenty-four-week period 2 SH and 3 PH patients died. The SH combination took longer to diminish the bacterial content of the sputum than the PH combination, but this was associated with larger numbers of bacteria in the sputum of some of the patients in the SH series at the start of the trial. No drug resistance was encountered in either series. Changes in the character of the sputum, and reduction in its daily volume, proved to be simple and valuable indices of progress. Anaemia was present in many of the patients before treatment. This improved at the same time as the tuberculosis, without specific treatment. It is concluded that both combinations are effective, and that the PAS-isoniazid combination is a powerful and valuable form of oral chemotherapy in East Africans.