Chemotherapy for patients with cultures resistant to streptomycin, isoniazid and pas

Abstract

The results are given of treating 122 patients with far advanced pulmonary tuberculosis and cultures resistant to streptomycin, isoniazid and PAS. 39 had surgical treatment and 83 had chemotherapy alone. The following drugs were used: ethionamide (0·5 g. twice daily), pyrazinamide (0·5 g. three times daily), cycloserine (0·25 g. three times daily), viomycin (1 g. daily or 2 g. twice a week. Fifty-five patients were treated initially with three of the secondary drugs for a minimum of three months, and an average period of 12 months; treatment was then continued with two drugs. Of this 55, 51 (93%) became negative on culture. Two patients with positive cultures did not take the drugs regularly. Another patient had one of the drugs (viomycin) intermittently and—as was discovered later—had no appreciable concentration of ethionamide in the serum after either oral or rectal administration of the drug. Four patients died, three of them after the sputum had become persistently negative. Twenty-eight patients had only two drugs initially: only 9 (32%) became negative. Fifteen died and in 13 of these the sputum was still positive. There was little difference between the three drug and two drug group in the severity of disease and other factors. The difficulties of treatment with the secondary drugs are emphasized. However, satisfactory results can be achieved if some basic rules and principles of good chemotherapy are observed, and if the patients are willing to co-operate.