A REVIEW OF THE CURRENT STATUS OF THE CHEMOTHERAPY OF TUBERCULOSIS

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Abstract
From a no. of different cooperative studies, carefully conducted with controls assigned at random, it has been possible to establish in the last few years the superiority of certain variables in the chemotherapy of tuberculosis. A combination of 1 g. of streptomycin (strepcin.) admd. twice a week with 12 g. daily of PAS, for periods up to 1 yr., has been found to result in a high degree of therapeutic efficacy and relatively little toxicity and drug resistance. Isoniazid (ison.) in combination with strepcin. or with PAS also appears to be effective, although the recency of its advent has not yet permitted as complete evaluation as with strepcin. and PAS. Results of chemoth. in general are less satisfactory after prior chemoth. than in "original treatment" patients, and this is in part related to drug resistance. When partial strepcin. resis. has developed as the result of prior strepcin. therapy, some benefit is nevertheless to be derived from continued strepcin. therapy unless that resis. is found to be as high as complete resis. to 100 [mu]g./ml. The availability of ison., as a 2d effective drug, improves the clinical outlook in these patients. When drug resis. to both strepcin. and ison. has developed, viomycin is found to be an effective antituberc agent, though probably of more limited efficacy than strepcin. or ison. It is desirable always to give combined therapy with more than one antituber. drug, and PAS appears to be the preferred drug to give with either strepcin. or ison. When intolerance to PAS exists, Terramycin may be employed as a substitute. Effective chemoth. in tuberc. results in the resolution of the reversible components of the disease in a high percentage of cases, leaving residual fibrosis and necrosis. The best clinical management of such residual tuberc. disease, in association with prolonged effective chemoth., has not been detd. with precision.