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• W4242665759 abstract "Eighty patients with pulmonary tuberculosis and coalworkers' pneumoconiosis were submitted for comparison of one, two or three years of standard chemotherapy (the duration being allocated at random) between November 1956 and May 1960; after exclusions there remained 57 (of whom 51 were aged 45 years or more) for analysis. The standard regimen prescribed was isoniazid 200 mg. daily with PAS (sodium salt) 10 g. daily in two equal doses, and 50 of the 57 patients had an initial supplement of streptomycin sulphate 1 g. daily in a single dose, the majority (30) for six weeks or less. At one year, quiescent disease had been achieved by 79% of the 57 patients; by 84% of the 50 who had streptomycin initially, and 3 (43%) of the 7 (who differed in the severity of disease and time of intake) who had no streptomycin. The difference is significant (P=0·03). Drug reactions occurred in 15 (26%) of the patients, 7 attributed to streptomycin and 8 to PAS, and also in 6 (26%) of the 23 patients excluded from the analysis. During the second year, bacteriological relapse occurred in 48% of 23 patients who stopped chemotherapy with quiescent disease at one year, and 6% of 17 who continued, a significant difference at the 1% level. During the third year, bacteriological relapse occurred in 3 of 10 patients who had stopped chemotherapy with quiescent disease at one year; there were no relapses among 10 patients who stopped at two years, nor among the 4 who continued chemotherapy for the third year. Comparing the relapse rates in the first year after stopping chemotherapy, 11 (48%) of 23 patients relapsed in the second year (after stopping chemotherapy at one year) compared with none of 10 in the third year (after stopping chemotherapy at two years), the difference is statistically significant (0·02>P>0·01). Of 7 patients who relapsed while on chemotherapy, 5 produced organisms resistant to one or more of the standard drugs, while 12 of 14 who relapsed after chemotherapy had sensitive organisms. There was a suggestion that the presence of large cavities initially was of prognostic importance; 35% of 23 patients with such cavities had an unfavourable response compared with 12% of 34 who had smaller or no cavities. A comparison was made between 105 male patients aged 45 years or more in the parallel M.R.C. trial of long-term chemotherapy in pulmonary tuberculosis and the 51 corresponding patients from the present study. Of those who had streptomycin initially, 88% of 68 patients with pulmonary tuberculosis compared with 82% of 44 with (on average less severe) pulmonary tuberculosis and pneumoconiosis had quiescent disease at one year. Among those who had no initial streptomycin the figures were 31 (84%) of 37 and 3 of 7, respectively; the difference is significant (P=0·04). Considering the second year, of those who had the initial streptomycin and stopped chemotherapy with quiescent disease at one year, 91% of 23 patients with pulmonary tuberculosis had quiescent disease at two years compared with 68% of 19 with pulmonary tuberculosis and pneumoconiosis; for those who continued chemotherapy during the second year the corresponding figures were 96% of 27 and 81% of 16, respectively. It is concluded from the present study that: One year of the prescribed chemotherapy was inadequate for patients with pulmonary tuberculosis and pneumoconiosis, but two years or more of this regimen led to better results. The addition of an initial streptomycin supplement improved the response to isoniazid plus PAS (the small numbers and differences in severity of disease and time of intake make this conclusion tentative). The presence of pneumoconiosis appeared to have an adverse effect on the response of pulmonary tuberculosis to the prescribed chemotherapy. The trial was co-ordinated jointly by Dr. J. Donald Ball from the Miners' Chest Diseases Treatment Centre and Dr. Joan Heffernan from the Tuberculosis Research Unit. The results were analysed and the report was prepared by Dr. Joan Heffernan (Tuberculosis Research Unit) and Miss Ruth Tall (Statistical Research Unit). The report should be referred to as: Medical Research Council/Miners' Chest Diseases Treatment Centre (1963) Tubercle, Lond, 44, 47." @default.
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• W4242665759 date "1963-03-01" @default.
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• W4242665759 title "Chemotherapy of pulmonary tuberculosis with pneumoconiosis" @default.
• W4242665759 doi "https://doi.org/10.1016/s0041-3879(63)80059-8" @default.
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