Treatment of Pulmonary Tuberculosis with ACTH and Cortisone in Addition to Specific Anti-Tuberculosis Therapy

Abstract

Beer-Yacov, Israel In these past years problems of the utmost practical importance have arisen in connection with the use of cortisoneand ACTH for patientswith pulmonary tuberculosis.Among them the followingare outstanding: 1. Does the use of ACTH or cortisonehave a deterioratinginfluenceon an activetuberculousprocessand can itcause a relapse in non-active tuberculous changes? 2. Will a combined treatment, adding antimicrobial drugs to these hormones, prevent unfavorable phenomena as above described? 3. Will the combination of antimicrobialdrugs with ACTH/cortisone influencethe tuberculous process favorably? 4. And if so,are there indicationsfor the use of steroidsin tuberculosis? Which are the suitable doses and what is the average length of time for their use? The firstexperiences with ACTH and cortisonein differentdiseasesand especiallyin rheumatic diseasesproved that not only in activebut even in arrested tuberculosisthe use of these drugs is contraindicated. Many cases have been observed in whom no tuberculosis was found prior to the use of these drugs and in whom severe active tuberculosis appeared after their use. In others a deterioration of inactive processes occurred or new disseminations were found. Supported by these experiences, the American Trudeau Society warned in 1952 against the use of ACTH and cortisonein tuberculous patients. In their opinion, even a non-active tuberculous process is a danger, potentially, for the patient who is treated with these drugs to combat other diseases. In the past two years these views have undergone considerable change. A number of investigatorshave shown that ACTH or cortisone in combination with antimicrobialdrugs not only are devoid of a negative