TREATMENT OF TUBERCULOSIS IN CHILDREN

Abstract

The history of antimicrobial therapy (AMT) of tuberculosis in children at the Wm. H. Maybury Sanatorium is reviewed; its superiority over previous treatment is emphasized by the change in mortality. The importance of treating early cases of primary tuberculosis is shown by comparing the results of 2 similar groups of cases, one treated with and the other without antimicrobial therapy. Although the AMT cases showed markedly better progress as shown by roentgenographic clearing and conversion of gastric and pharyngeal cultures, the occurrence of temporary worsenings could not be prevented. The freshness of the disease seemed to be the most important factor in the development of worsening. In the AMT group they cleared more promptly and left less residuals than in the controls. Worsening was more likely to occur in the persistently positive culture cases among the controls but not among the AMT cases. The various regimens of antimicrobial therapy are discussed; isoniazid is considered to be a necessary part of each AMT combination for the first year. The need for early diagnosis is emphasized and the values of early treatment are discussed. One of the weakest links in the antimicrobial therapy of tuberculosis in children would seem to be the delay in its use until the organisms have created large areas of caseous necrotic tissue in which to barricade themselves. If we knew the tuberculin reaction of all children and could start treatment at the time of conversion and continue for 9 to 12 months we should be able to eliminate generalized tuberculosis and prevent the possibility of endogenous reinfection later in life.