The results of treatment in patients with cultures resistant to streptomycin, isoniazid and PAS: A five-year follow-up

Abstract

Summary The late results, five years after the start of treatment, are given in 122 patients with far-advanced tuberculosis and cultures resistant to streptomycin, isoniazid and PAS. Thirty-nine had chemotherapy and early surgical treatment and 83 had chemotherapy alone (surgical treatment was used in four after a relapse). 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 of the 83 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. Fifty-three (96%) became negative on culture. In two patients the treatment failed initially; both had one of the drugs (viomycin) intermittently and, as discovered later, one had no appreciable concentration of ethionamide in the serum after either oral or rectal administration of the drug. Eight (14%) had a late bacteriological relapse. They did not take drugs regularly. In four of them the cultures became resistant to secondary drugs. Five became negative again with further treatment (two of them after surgery). Ten patients died, six of them after the sputum had become persistently negative. Twenty-eight patients had only one or two drugs initially: only 11 (40%) became negative, three of them after retreatment with three-drug combinations. Nineteen died and in 16 of these sputum was still positive. There was no significant difference between the three-drug and two-drug group in the severity of disease and other relevant factors. The difficulties of treatment with secondary drugs are emphasized. However, satisfactory long-term results can be obtained if some basic rules and principles of good chemotherapy are observed, and if the patients are willing to co-operate.