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• W4247486288 abstract "The results up to 3 years have been presented for a controlled clinical trial in Hong Kong, undertaken to evaluate the role of pretreatment sensitivity tests to streptomycin, isoniazid and PAS in the selection of regimens of chemotherapy for patients with pulmonary tuberculosis, of whom 25 per cent had received previous chemotherapy for up to 4 months.The 3 policies studied at random were: •Policy A: Streptomycin, isoniazid and PAS, followed by isoniazid and PAS, ignoring the pretreatment sensitivity test results.•Policy B : The above standard chemotherapy, but introducing other drugs if the pretreatment strain was resistant in a standard indirect sensitivity test.•Policy C: A slide culture sensitivity test was performed before the start of treatment and appropriate regimens were selected in the light of the results.After exclusions, 527 patients remained in the analysis up to 3 years, 174 on Policy A, 182 on Policy B and 171 on Policy C, 32 per cent, 25 per cent and 33 per cent respectively having drug-resistant strains on standard indirect sensitivity testing on admission, the proportions resistant to 2 or all 3 drugs being 14 per cent, 10 per cent and 13 per cent.The proportions of patients with a favourable response throughout the 3 years were 88 per cent for Policy A, 87 per cent for Policy B and 90 per cent for Policy C, the findings for the patients with sensitive strains on admission being 97 per cent, 88 per cent and 91 per cent respectively and for patients with resistant strains on admission 69 per cent, 87 per cent and 88 per cent respectively.After changes of chemotherapy were made for the patients who failed on their first regimen, the final success rates achieved at 3 years were 95 per cent on Policy A, 95 per cent on Policy B and 96 per cent on Policy C, the results for the patients with sensitive strains on admission being 97 per cent, 95 per cent and 96 per cent respectively and for those with resistant strains 91 per cent, 93 per cent and 96 per cent respectively.On Policy A 24 of 31 patients with resistance to 1 drug had a favourable response throughout the 3 years, as did 12 of 17 with resistance to 2 drugs and 2 of 7 with resistance to all 3 drugs. After changes of chemotherapy the numbers with a favourable response increased to 29, 15 and 6 respectively.The failure rate in patients with fully sensitive organisms who were treated with the standard chemotherapy was 8.4 per cent, due to a failure to self-administer drugs in the continuation phase of chemotherapy. An estimated failure rate of 5.2 per cent resulted from the high (30 per cent) prevalence of pretreatment drug resistance in the patients on Policy A.More reserve drugs were prescribed and there was more drug toxicity in the patients on Policies B and C, which are also less simple to implement than Policy A and depend on the availability of accurate sensitivity testing.Two subsidiary investigations were also undertaken in the study. In one the patients were randomly allocated to 3 or 6 months of triple chemotherapy in the initial intensive phase.The results show no benefit from 6 months triple chemotherapy over 3 months. In the second the patients were randomly allocated to either 18 or 24 months treatment. The benefit obtained from 24 onths treatment was at most slight." @default.
• W4247486288 created "2022-05-12" @default.
• W4247486288 date "1974-09-01" @default.
• W4247486288 modified "2023-10-18" @default.
• W4247486288 title "A study in Hong Kong to evaluate the role of pretreatment susceptibility tests in the selection of regimens of chemotherapy for pulmonary tuberculosis — Second report" @default.
• W4247486288 doi "https://doi.org/10.1016/0041-3879(74)90045-2" @default.
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