Streptomycin plus pyrazinamide in the treatment of patients excreting isoniazid-resistant tubercle bacilli, following previous chemotherapy.

Velu, S.; Andrews, R.H.; Angel, J.H.; Devadatta, S.; Wallace Fox;
George Jacob, P.;Narayanan Nair C. C.; Ramakrishnan, C.V.

Tubercle; 1961; 42; 136-147.

Fifty seven patients with chronic pulmonary tuberculosis and organisms sensitive to streptomycin were treated with daily streptomycin plus pyrazinamide, the majority attending a clinic daily for the therapy; all had previously been treated either with isoniazid plus PAS or with isoniazid alone.

          The streptomycin plus pyrazinamide regimen was stopped in 20 patients before the end of a year because the disease was active, and 1 more patient died.

          Of the 36 patients who completed 1 year's treatment, 32 had attained bacteriological quiescence and 1 more is considered to have done so. Sputum conversion was very rapid in those patients who attained bacteriological quiescence. Patients whose response was unsatisfactory usually had a clear 'fall and rise' in the bacterial content of the sputum associated with the emergence of strains highly resistant to streptomycin.

          Extensive or moderate cavitation, a large total extent of the radiographic lesion and heavily positive sputum on smear examination were relatively unfavourable prognostic signs. Age and sex were not of prognostic importance.

          Toxicity to streptomycin was not a problem. Liver toxicity to pyrazinamide was not encountered, but joint pains occurred in 15 patients 6 of whom had a gouty syndrome. Seven patients received the combination throughout pregnancy, without developing toxic manifestations.

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