COMBINED DRUG TREATMENT OF TUBERCULOSIS. III. CLINICAL APPLICATION OF THE PRINCIPLES OF APPROPRIATE AND ADEQUATE CHEMOTHERAPY TO THE TREATMENT OF PULMONARY TUBERCULOSIS

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Abstract
Three hundred and eighteen adult patients with bacteriologically proven pulmonary tuberculosis due to typical tubercle bacilli were treated for at least 6 months. Of these, 153 were excreting populations susceptible to both streptomycin and isoniazid. These patients were subjected to a high dosage streptomycin, high dosage isoniazid chemotherapeutic regimen. One hundred and fifty-two of these 153 patients became bacteriologically converted to negative before the end of the 6th month of chemotherapy. None of these 152 patients excreted drug-resistant populations prior to conversion. There was one early chemotherapeutic failure, as manifested by failure to achieve conversion and by the emergence of double-drug-resistant mutants. There was also one bacteriologic and roentgenographic relapse. Two other groups of patients who were already excreting drug-resistant organisms on admission to hospital were studied for comparison: those excreting populations resistant to one drug, and those resistant to 2 drugs. Neither group demonstrated impressive response to chemotherapy. These results established the value of the special drug-susceptibility testing techniques employed for predicting the clinical response to adequate or more than adequate treatment with streptomycin and isoniazid.