Medical management of pulmonary tuberculosis.

Abstract

During the past few years chemotherapy has become the cornerstone in the treatment of all forms of active tuberculosis. This is certainly true of pulmonary tuberculosis. Since streptomycin came into general use ten years ago as an effective antituberculosis agent, several other drugs have proved to be valuable additions to the armamentarium. The following basic principles (1) in the treatment of pulmonary tuberculosis have now become generally accepted in the United States. 1. All patients with active pulmonary tuberculosis or any of its complications should receive chemotherapy. This definitely includes tuberculous pleurisy with effusion, which, when inadequately treated, results in some form of active tuberculosis within five years in 25 to 62 per cent of the cases (2, 3). 2. The drug regimen should include at least two drugs given concurrently. 3. Chemotherapy should be uninterrupted and prolonged—for at least one year and often for two or more years, depending on the amount and type of residual disease present. In some cases chemotherapy should probably be given indefi-nitely. Though these principles are widely accepted among tuberculosis physicians, they seem to require renewed emphasis from time to time for the benefit of the physician who treats tuberculosis only occasionally. It is not the intent of this paper to present a review of all the various regimens which have been reported as effective by the many investigators in this field. Rather, it is our hope to deal with presently accepted general principles involved in the treatment of pulmonary tuberculosis, the regimens most commonly used, and the results which may be expected depending upon the amount, type, and distribution of the disease processes Major Antimicrobial Agents The three major antimicrobial agents used today in treatment of tuberculosis are isoniazid, streptomycin (and its hy-drogenated derivative, dihydrostreptomy-cin), and para-aminosalicylic acid. Isoniazid, first introduced in 1952 (4, 5), has proved to be probably the most ef-fective—and cheapest—of the antituberculosis agents. It is strikingly effective in reducing cough, expectoration, fever, and malaise, and in improving the weight and general well-being of the patient. With the usual dosage of 3.0 to 5.0 mg. per kilogram of body weight, toxic side-reactions seldom occur. These consist chiefly of peripheral neuritis, hyperre-flexia, and positional hypotension. The latter two, when they do occur, are rarely serious. They often subside or disappear without discontinuance of the drug. When peripheral neuritis occurs, the dosage should be lowered or the medication interrupted until symptoms subside. The addition of pyridoxine (vitamin B6) in doses of 25 to 100 mg. t.i.d. is quite helpful in the management of such cases.