A 5-Year Study of Patients with PulmonaryudTuberculosis Treated at Home in a ControlledudComparison of Isoniazid plus PAS with 3 Regimensudof Isoniazid Alone

摘要

This report from the Tuberculosis Chemotherapy Centre, Madras, describes theprogress,udover a 5-year period, of 341 patients with newly diagnosed, sputum-positive tuberculosis. Alludthe patients were treated on a domiciliary basis. In the first year, the patients received,udon the basis of random allocation, a standard regimen of isoniazid plus PAS or 1 ofud3 regimens of isoniazid alone. Previous reports have shown that the response in the firstudyear was substantially superior with the standard regimen, and that the bacteriologicaludrelapse rates in the second year were fairly similar for the 4 regimens. The findings inudthe present report extend the latter conclusion to the end of 5 years. Further, when consideredudtogether with the findings in an earlier study, they have shown that isoniazid,udgiven as maintenance chemotherapy in the second year, was highly effective in preventingudbacteriological relapse in patients who, at 1 year, had bacteriologically quiescent diseaseudand no residual cavitation ; the effect was, however, less marked in patients with residualudcavitation at 1 year.udPatients who were clear-cut failures of the allocated chemotherapy and those who haduda bacteriological relapse in the second or subsequent years were usually re-treated withudstreptomycin plus PAS or streptomycin plus pyrazinamide, and if this was ineffective,udwith cycloserine plus thioacetazone or cycloserine plus ethionamide.udConsidering the findings over the 5-year period for all patients, 16 died from nontuberculousudcauses and 1 took his discharge prematurely. Of the remainder, 86% hadudbacteriologically quiescent disease at 5 years, 6 % had bacteriologically active diseaseudand 8 % had died of tuberculosis. These findings confirm the value of well-organizeduddomiciliary chemotherapy, which was established by an earlier report from the Centre,udand are particularly encouraging for developing countries such as India, where tuberculosisudis a major problem and resources are limited