Chemotherapy of pulmonary tuberculosis in young adults

Abstract

The results of three Medical Research Council trials of chemotherapy in pulmonary tuberculosis have been amalgamated to provide material for a detailed analysis. 388 patients- with similar forms of acute progressive bilateral pulmonary tuberculosis have been studied in these trials 52 were treated by rest in bed only, 109 by streptomycin alone, 59 by P.A.S. alone, 73 by streptomycin plus 5 or 10 g. of P.A.S. daily, and 95 by streptomycin plus 20 g. of P.A.S. daily. The results at six months after the start of treatment were much better in all groups on chemotherapy than in the group on rest in bed alone. They were much better in groups receiving streptomycin than in the group having P.A.S. only, and better in groups on combined therapy than in those on streptomycin alone. There was no apparent difference between the groups having different daily doses of P.A.S. plus 1 g. of streptomycin daily. There was no difference between the results in men and those in women. The percentage of patients developing streptomycinresistant strains was much higher in patients treated with streptomycin only than in those on combined therapy; among the latter it was higher in those patients for whom the daily dose of P.A.S. was 5 or 10 g. than in those receiving 20 g. daily. The clinical significance of streptomycin resistance is discussed. In patients with a similar initial condition the results were worst in those who developed high degrees of drug resistance. Moderate drug resistance seems to be of less clinical significance. © 1952, British Medical Journal Publishing Group. All rights reserved.