A controlled trial of 2-month, 3-month, and 12-month regimens of chemotherapy for sputum smear-negative pulmonary tuberculosis: The results at 30 months.
Hong Kong Chest Service; Tuberculosis Research Centre; Council, British Medical Research.
American Review of Respiratory Disease; 1981; 124; 138-142.
Of 1,033 Chinese patients with radiologically active pulmonary tuberculosis but with sputum negative for acid-fast bacilli on 5 initial microscopic examinations, 370 (38%) had 1 or more initial sputum cultures that yielded tubercle bacilli. All patients were randomly allocated to (1) selective chemotherapy, anti-tuberculosis chemotherapy not being started until active disease had been confirmed, or to (2) daily streptomycin, isoniazid, rifampin, and pyrazinamide for 2 months or (3) the same 4 drugs daily for 3 months, or to (4) a 12-month control regimen. In patients with 1 or more of their initial sputum cultures positive, the short-course regimens were inadequate, being followed by bacteriological relapse rates of 15 and 9%, respectively, during 30 months, compared with 0% in the control series. In patients with all their initial cultures negative, the corresponding relapse rates were 4,2 and 0%, and in the selective chemotherapy series, 53% of the patients had treatment started during the 30 months because active disease was confirmed (bacteriologically in 40%). It is important to continue studying short-course chemotherapy for smear negative patients because in many countries they represent a high proportion of those treated.
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