| A Clinical Study of the Effectiveness of Secondary Anti-Tuberculosis Drugs in the Treatment of Pulmonary Tuberculosis |
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Jie Young Han, Byung Jung Song |
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Korean Tuberculosis Association Seoul Branch Associate Member, Korea |
| 이차항결핵제의 임상효과에 관한 관찰 |
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한지영, 송병정 |
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| Abstract |
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The clinical effectiveness of secondary anti- tuberculosis drugs was studied on 272 active pulmonary tuberculosis patients who were bacteriologically and clinically resistant to primary and some secondary drugs.
The patients were treated for 18 months and they were divided into 5 groups according to regimen.
Group Ⅰ consisted of 51 cases being treated with a secondary drug(either INH-TH (1321) or INHEM).
Group Ⅱ consisted of 91 cases being treated with two secondary drugs (either INH-TH(1321)-PZA or INH-TH(1321)-CS).
Group Ⅲ consisted of 86 cases being treated with two secondary drugs including EM(either INHEM-TH(1321). INH-EM-PZA or INH-EM-CS).
Group Ⅳ consisted of 27 cases being treated with three secondary drugs including EM(INH- EMTwo other secondary drugs).
Group Ⅴ consisted of 17 cases being treated with Rifampicin 450-600mg twice a week) and another secondary drug.
Direct smear sputum tests were given (with culture tests performed after any two consecutive smear negative results) and chest X-ray examinations were performed every 3 months during the 18 months of chemotherapy.
Effectiveness was evaluated (both bacteriologically and radiologically) every 3 months.
Sputum negative conversion rates after 3 months. 6 months. 9 months. 12 months. 15 months and 18 months of chemotherapy were as follows :
Group Ⅰ rates were 56.9% . 49.0%. 33.3% . 31. 4% 31.4% and 31. 4% .
Group Ⅱ rates were 46.2%. 48. 4% . 46. 2%. 48. 4%. 48.4% and 48.4% .
Group Ⅲ rates were 51. 2% . 70.9%. 76. 7%. 77. 9%. 75.6% and 75.6% .
Group Ⅳ rates were 63. 0%. 77. 8%. 81.5%. 81. 5%. 81. 5% and 81. 5%.
Group Ⅴ rates were 70.6% 88.2%. 88. 2%. 88. 2%. 88. 2% and 88.2% respectively.
The X-ray improvement rates after 6 months. 12 months and 18 months of chemotherapy were as follows:
Group Ⅰ rates were 47.1%. 43.1% and 37.3%.
Group Ⅱ rates were 53.8%. 54.9% and '48.4%.
Group Ⅲ rates were 60.4%. 64.0% and 62.8%.
Group Ⅳ rates were 74.1%. 74.1% and 74.1%.
Group Ⅴ rates were 70.6%. 82.4% and 82.4% respectively.
Considering all the negative sputum conversions in all the groups. the vast majority (90.2%) of sputum conversions occured within the first 6 months (after 3 months: 64. % and after 6 months: 26.2% ).
So it can be seen that with continued chemotherapy for next 6 months. only 9. 8% were converted.
After 18 months of chemotherapy. bacteriological positive relapse rates were 61. 9% in
Group Ⅰ. 31. 3% in Group Ⅱ. 17.7% in Group Ⅲ. 8.3% in Group Ⅳ and 6.3% in Group Ⅴ.
The X- ray improvement in all the groups was not remarkable. and after 12 months and 18 months of chemotherapy. the X- ray improvement are almost negligible when compared with that after 6 months.
Judging from the above results. Group V was seen to. be the most effective regimen. followed by Group Ⅳ. Group Ⅲ. Grollp Ⅱ and Group Ⅰ. in that order. and it was also noted that Group Ⅳ (Triple secondary drugs including EM) was not particularly better than Group Ⅲ (Two secondary drugs including EM).
Since Group Ⅰ (INH-single secondary drug) showed very poor results; such a regimen does not seen to be desirable for retreatment tuberculosis patients. |
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