One of the most important problems encountered in the chemotherapy of the
tuberculosis is to decide the degree of resistance of the tuber bacilli against the
antituberculous agent in use.
The has been no agreement on a standard procedure for this continuing chemotherapy
according to the degree of resistance and many different opinions have been expressed
by workers in different countries.
It has been noted that, even when the degree of resistance is high, continuation of the
chemotherapy produces improvement in subjective symptoms and sputum and X-ray
findings. This could partially be explained by the incomplete resistance of the bacilli but
there are many discrepancies between the problem of resistance and clinical results. It is
felt thats this discrepancies originate from the deficiencies in the method being used at
present and the sensitibity tests.
Tubercle bacilli which have been in contact with combined antituberculous agents for
a prolonged period are seperated and tested in the "seperate" medium to which
streptomycin, P.A.S. or I. N. H has been added singly. By witnessing the death or
growth of the bacilli, we generally determine the sensitibity of the bacilli in cases of a
"combined" chemotherapy. it is felt that clearly this is an unsatisfactory method and this
should explain why these are so many discrepancies between the results of current
sensitibity tests and the clinical outcomes.
In order to make some improvements on the sensitibity test in combined
chemotherapy, following research has been carried out using "seperate" and "compound"
methods.
This is the first report in this service.
Table 1 shows the series of media.
Table 2 shows the results of "seperate"
and "compound" methods in the sensitibity tests in those combined chemotherapy cases
who received streptomycin, and P. A. S., streptomycin and I.N., P.A.S. and I.N.H. or
streptomycin, P. A. S. and I. N. H. or streptomycin, P. A. S, and I. N. H. at this
institution.
The results institution.
Among 11 cases (excluding 4 cases in whom culture was negative), only 2 (# 7 and
14) had no discrepancy between "seperate" and "compound"
In 6 Gases (# 8,9,11,12,13 and 15) discontinuation of chemotherapy seems indicated
according to the present "seperate" sensitibity test. However, examination by the
"compound" method shows the advisa bility of continuing combined chemotherapy in this
case.
The results in cast #1 and5f suggest that the use of "compound" depended in selected
cases may reveal the existence of a "compound" depended strain, when the "seperate"
sensitibity test shows negative result.
It is felt that this problem must be studied in a larger series of cases and the results
checked against clinical outcomes.
|