Clinical and Biological Investigations on the New Antituberculosis Drugs (Pyrazinamide and Cycloserine)

Abstract

Pyrazinamide Up to now at the Carlo Forlanini Institute, about 100 patients have been treated with pyrazinamide.� Here we will report only a first group of 30 patients having undergone a whole regimen of therapy (four to six months), and for whom a number of biological tests were carried out that will be reported elsewhere. The above mentioned 30 patients (15 men and 15 women) were affected by various forms of pulmonary tuberculosis, of which 11 were moderately advanced (one essentially exudative, ten essentially productive) and 19 chronic (six essentially exudative, two with residual cavitation, one tuberculoma). Of these chronic forms, four (two productive, two exudative) showed some exacerbation phenomena at the start of pyrazinamide therapy. All patients had already received prior therapy with other antibiotics and antituberculosis chemotherapeutic agents, and most of them had presented tuberche bacilli in sputum more or less resistant to streptomyci isoniazid and PAS. Except for some cases without clinical findings, the objective auscultatory findings of the lungs were quite prominent. Patients were carefully selected so as to eliminate any that had evidence of hepatic dysfunction. The daily dose of the drug (divided into five times a day) was 2.5 gr. gradually reached at the fourth day of treatment. In addition to routine roentgenographic, planigraphic and laboratory examinations (B.U.N., F.B.S., urine, and sputum analyses), repeated controls were carried out. These were related to the peripheral blood count, serum electrophoresis, the phagocytosis index, MiddlebrookDubos test, P.B.I. urinary 17-ketosteroids, behavior of the specific proteases, serum lipase power, serum cholesterol, serum bilirubin, plasma fibrinogen, prothrombin time, colloidal serolabihity tests, hippuric acid and B.S.P. tests. In Table I the important clinical roentgenographic and laboratory results are summarized, before and after 80 days of therapy. The drug tolerance in the doses we used was generally good, except for appearance of arthralgic phenomena in three patients; in one, symp-�toms started after a few days’ treatment and were present in the articulations of the upper and lower members, but without tumefaction. It is to be noted that such arthralgic phenomena completely disappeared with