Treatment of patients with pulmonary tuberculosis classified according to the history of previous chemotherapy and without reference to pre-treatment drug sensitivity

Abstract

Patients with pulmonary tuberculosis can be classified into groups according to the history of previous chemotherapy. One group includes patients who deny any previous treatment, those who admit to not more than 30 days treatment regardless of its quality, and those who admit to treatment of longer than 30 days but in whom the treatment has been of good quality. In such patients it is unnecessary to carry out sensitivity tests, for good results with an initially triple-drug regimen (streptomycin, isoniazid and PAS) can be achieved without them. In 106 patients in whom sensitivity tests were not done 100% sputum conversion on smear examination was obtained after five months. In a similar group of 103 with cultures reported sensitive to all three drugs 100% conversion was obtained after four months. In Rio de Janeiro 81% of 913 patients in this category treated by a simple standard regimen without sensitivity tests were classed as ‘bacteriologically favourable’ after one year. Relapse was rare -only 1·6% during a minimum of 22 years observation. Similar good results can also be obtained in underdeveloped areas, if the organization of treatment services is efficient. For instance, in an area of Bahia in which all the health centres could do smear examinations but few had x-ray facilities, 75% of 529 patients were classed after a year as `bacteriologically favourable' and only 7 % had defaulted from treatment.