The use of INH in pulmonary tuberculosis

Abstract

Preliminary observation of the course of each particular case of pulmonary tuberculosis is essential in order to accurately assess the effect of the drug. In 66 cases of pulmonary tuberculosis receiving INH for periods of up to seven months — initial doses being 2–3 mg./kg. increasing to 5–8 mg./kg. — the following results were obtained: Improved ........ 15 Improved at first but then no further improvement ........ 2 Relapsed after initial improvement 20 Unchanged ........ 21 Becoming worse ........ 8 Graphs show initial improvement as suggested by B.S.R., bacillary counts in sputum, x-rays and cavity size. After two months' treatment relapses occur and after three months the poor results tend to outweigh the good. In comparison with the initial condition results after 3 months' treatment with INH are worse than after two months. Combined treatment with streptomycin and PAS is superior to INH alone in all criteria. The most regular effect of INH is to be expected on spreads and primary tuberculosis of hilar lymph glands. Tissue lysis in infiltrative pulmonary tuberculosis has to be borne in mind. Treatment with INH and PAS seems to be superior to treatment with INH, regarding the intensity and regularity of the effect. But there is no definite conclusion, whether resistance against INH appears later whilst giving PAS together with INH. INH is not suitable for unplanned or ambulatory treatment. Sometimes unexpected occurrence of resistance of bacilli with relapse of tuberculosis makes a rapid change of therapy necessary. Principles of conservative or collapse therapy remain unchanged.