Combined Intermittent Regimens in the Treatment of Non-Miliary Pulmonary Tuberculosis: A Comparison of Streptomycin Every Third Day and Para Aminosalicylic Acid Daily with Streptomycin Every Third Day and Para Aminosalicylic Acid Every Third Day

Abstract

1)A comparison of two groups of patients with proved pulmonary tuberculosis of moderate and far advanced extent has been presented. One series of 95 patients was treated with streptomycin every third day and para aminosalicylic acid daily for 120 days; the other series of 103 patients received streptomycin every third day and para aminosalicylic acid every third day for 120 days. Six months follow-up study has been completed on 81 and 54 patients respectively. 2)Both groups were compared in regard to age, sex, race, extent of disease, pathological type, roentgenographic and clinical status at the start of therapy. 3)Results of treatment evaluated at the 120 day point and at six months post treatment were as follows: (a)Clinical response was approximately equivalent for the two regimens at 120 days. Further improvement occurred during the follow-up period in both groups, but to slightly greater extent in those treated with streptomycin every third day and para aminosalicylic acid daily. (b)Marked roentgenographic improvement was observed during 120 days of therapy and at six months post treatment with both regimens. No worsening occurred during the 120 days of therapy. Only 20.5 to 26.2 per cent of cavitary cases had apparent cavity closure during treatment, but 60.0 to 66.7 per cent had cavity closures during the six month follow-up period, due largely to addition of operative procedures. (c)On the two regimens 66.3 to 69.9 per cent of the patients had negative sputa after 120 days. The proportion remained approximately the same at the six month evaluation. (d)None of the patients treated with streptomycin every third day and para aminosalicylic acid daily for 120 days yielded tubercle bacilli resistant to either drug. Of the patients treated with both drugs every third day nine or 29.0 per cent of those with positive cultures, or 8.7 per cent of the total yielded organisms resistant to streptomycin after 120 days of treatment. Bacterial did not appear in these nine patients until they had received an average of 106 days of drug therapy. Comparison of the patients whose sputa yielded resistant organisms to those whose sputa yielded sensitive organisms after treatment revealed no material difference. A phenomenon of loss of bacterial resistance to streptomycin was encountered, and its significance discussed briefly. Bacterial to para aminosalicylic acid did not occur. Comparison of the incidence of bacterial to streptomycin encountered in the series treated with both drugs every third day in comparison to earlier studies performed according to the same methods in the same laboratory revealed a lower incidence of sensitivity when both drugs are administered every third day than when either is administered alone daily, or in the case of streptomycin, every third day. (e)Drug toxicity was not a major problem in either regimen. Significantly less gastro-intestinal disturbance was encountered when para aminosalicylic acid was administered every third day.