A two-year follow-up of patients with quiescent pulmonary tuberculosis following a year of chemotherapy with an intermittent(twice-weekly) regimen of isoniazid plus streptomycin or a daily regimen of isoniazid plus PAS.
Nazareth, O.; Devadatta, S.; Evans, C.; Wallace Fox; Janardhanam, B.; Menon, N.K.; Radhakrishna, S.; Ramakrishnan, C.V.; Stott, H.; Tripathy, S.P.; Velu, S.
Tubercle; 1966; 47; 178-189 and Indian Journal of Tuberculosis; 1967; 14; 95-103.
In the main analyses of a year's study of twice-weekly high dosage isoniazid plus streptomycin (SHTW) in comparison with a standard daily regimen of isoniazid plus PAS (PH) under domiciliary conditions, 66 SHTW and 53 PH patients had attained bacteriologically quiescent disease at one year. All the patients have now been followed-up over a two-year period. Of these, 66 SHTW and 52 PH patients had been allocated at random to treatment the second year with isoniazid alone or with placebo. No patient was prescribed anti-tuberculosis drugs for the third year.
The condition of the patients in the two series was broadly similar, both at the time of their original admission to treatment and also at the start of the period of follow-up.
There were five deaths (four SHTW, one PH) in the follow-up period, all the second year and all from non-tuberculous causes; all five patients produced only negative cultures in the second year and for at least six months immediately before death.
The radiographic progress was similar for the two series in the second and third years, the majority of patients in both series showing little change.
The patients were under intensive bacteriological investigations, an average of 14 cultures being examined per patient in the second year and nine in the third year. A bacteriological relapse occurred in five (8%) SHTW and six (12%) PH patients. In one and two patients respectively, this was associated with a serious radiographic deterioration. An isolated positive culture was produced by 17% of the SHTW and 27% of the PH patients.
Four of the SHTW patients had a relapse with streptomycin- and isoniazid-sensitive cultures and four of the PH patients with isoniazid-sensitive cultures.
It is concluded that bacteriological quiescence following a year of twice-weekly isoniazid plus streptomycin is at least as stable, over a two-year period of follow-up, as that of attained following a year of a standard daily oral regimen of isoniazid plus PAS.
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