| A Clinical Study on Chemotherapy for Active Pulmonary Tuberculosis Patients in Korea: Part 1. The Clinical Effects of Combined Chemotherapy using Major Drugs on Ambulatory Basis, Part 2. The Clinical Effects of Newer Anti-tuberculous Agents and Special Us |
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Ki Ho Kim, Kwang Hyun Cho |
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Department of Internal Medicine Yonsei University Medical School, Seoul, Korea |
| 한국인 폐결핵환자의 화학치료에 관한 임상적 연구: 제1편 일반 항결핵제를 사용한 통원치료에 관하여, 제2편 특수 항결핵제와 특수방법에 의한 화학치료에 관하여 |
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김기호, 조광현 |
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| Abstract |
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Recent advances in the treatment of tuberculosis especially chemotherapy has brought a considerable change in the concept of this dreadful disease. Before the era of chemotherapy, rest was considered the most important portion of the treatment of pulmonary tuberculosis. However, since the introduction of effective drugs the value of rest has apparently decreased. Thus it causes less economic burden for the care of tuberculosis individually as well as nationally. It is particularly significant in those areas where sufficient hospital facíllities are not available for all discovered active pulmonary tuberculosis patients. This paper is to report the results of investigation on the ambulatory chemotherapy for 676 active pulmonary tuberculosis patients and the clinical effects of various regimens of combined major drugs. Four regimens of chemotherapy have been employed: 1. Streptomycin.PAS 168 patients (25 percent) of total treated patients, 2. Streptomycin-isoniazide 98 patients(14. 6 percent). 3. PAS-isoniazide 380 patients(56 percent) . 4. Twenty-one patients also received triple drug combination treatment in consideration oÍ the seriousness of the disease. The isoniazide alone was nine patients(1. 3 percent).
The majority(87 percent) of above patients who have visited the clinic showed moderately or far advanced disease and more than half of the pati ents received chemotherapy regularly or irregular.
ly before they visited clinic. A comparative study of different combined regimens as to bacteriological and roentgenological results before and after chemotherapy revealed the best result in the PAS-isoniazide regimen and order of Streptomycin-isoniazide, Streptomycin-PAS-isoniazide and Streptomycin-PAS, the least effecte of all.
Since the advancement of anti-tuberculous chemotherapy by the development of SM, PAS and INH, most of the active pulmonary tuberculosis have been almost successfully treated by the combined use of three major drugs, especially by a long-term chemotherapy. However, the application of major drugs which are widely used has a certain limitation of their actions. The emergence of bacterial resistance induced by the long-term chemotherapy increases the number of patients whose therapeutic effect cannot be expected from the use of ordinary drugs. Some of these cases are probably too far progressed to be effective and the others who have become ineffective to these drugs due to inadequate and irregular drug therapy previously. Therefore, new agents which have no cross-resistance with the major drugs and have a stronger bacteriocidal action have been widely sought. Author has already discussed the clincial effects of combined chemotherapy using major drugs in previous chapter. This paper is to report the clinical effects of newer anti-tuberculous agents such as Cycloserine, Nicotinaldehyde thiosemicarbazone, a massive use of isoniazid and a combined th erap y with Steroid hormone in this chapter. The combined therapy of Cycloserine-isoniazid (10 cases), massive isoniazid therapy (10 cases),
and Steroid hormone therapy (9 cases) for the relatively advanced chronic pulmonary tuberculosis patients; and the combined therapy of Nicotinaldehyde thiosemicarbazone-isoniazid for ten patients who have no previous chemotherapy have been tried. A clinical study on the effect of these treatments has been made and the following results were obtained. At the end of 6 months Cycloserine-isoniazid combined therapy, 3 cases out of 10 showed negative conversion of sputum and 4 cases showed improvement of the lesions and diminution of cavity size in the X-ray findings. During the course of the treatment, no serious side reactions have been noted and it appears that the combined use of Cycloserine 0.5 gm daily and Isoniazid can be safely employed for the ambulatory patients.
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