| Popis: |
1. One hundred fourteen patients were treated with the combination INH-PZA for periods of one to 25 months. 2. Of eight showing no change on roentgen evaluation at the fourth month of treatment, it is considered significant that all eight had achieved bacteriological “conversion” and that five of the eight had persistent open cavity with negative sputum. Of 58 moderately and far-advanced cases, 22 showed marked improvement, 17 moderate improvement, 10 slight improvement, and only one showed worsening. 3. Of 55 treated at least four months with moderately and far-advanced disease, 80 per cent achieved bacteriological negativity during the first two months, with the vast majority doing so during the first month of treatment. An additional 13 “converted” during the third and fourth months. Four patients (7 per cent) remained positive, and they all became resistant to INH within two months. 4. Of 19 cases with a cavitary component 4 cm. or more, 11 became “open negative,” four became “closed negative,” and four remained “open, positive, resistant.” Evidence of hepatic toxicity was obtained in 15 per cent of 114 cases only by an abnormal liver function test. Clinical hepatic involvement as well occurred in an additional 4 per cent. There was one death with jaundice; its relationship to PZA is doubtful. All evidence of hepatic toxicity, clinical or laboratory, appeared in a scattered fashion during the first 10 months of treatment; no toxicity was detected in 12 cases receiving PZA for 10-25 months. 5. The achievement of bacteriological negativity with persistence of open large cavity appears to happen much more often with INH-PZA than with various combinations of SM, INH and PAS. 6. The major disadvantage of INH-PZA therapy is the hepatotoxicity of PZA which manifests itself in most of the cases only by abnormal laboratory tests. Because of this it is felt that INH-PZA should be used only in those cases in whom frequent liver function studies can be done, and that further effort should be directed towards finding more sensitive laboratory indices of early PZA toxicity. |
