Recent advances in the treatment of tuberculosis especially chemotherapy has brought
a considerable change in the concept of this dreadful disease. Before the era of
chemotherapy, rest was considered the most important portion of the treatment of
pulmonary tuberculosis. However, since th introduction of effective drugs the value of
rest has apparently decreased. Thus it causes less economic burden for the care of
tuberculosis individually as well as nationally. It is particularly significant in those areas
where sufficient hospital facillities are not available for all discovered active pulmonary
tuberculosis patients.
The paper is to report the results of investigation on the ambulatory chemotherapy for
676 active pulmonary tuberculosis patients and the clinical effects of various regimens of
combined major drugs. Four regimens of chemotherapy have been employed : 1.
Streptomycin-PAS 168 patients (25 percent) of total treated patients, 2.
Streptomycin-isoniazide 380 patients(56 percent), 4. Twenty-one patients also received
triple drug combination treatment in consideration of the seriousness of the disease. The
isoniazide alone was nine patients(1.3 percent).
The majority(87 percent) of above patients who have visited the clinic showed
moderately or far advanced disease and more than half of the patients received
chemotherapy regularly or irregularly before they visited clinic. A comparative study of
different combined regimens as to bacteriological and roentgenological results before and
after chemotherapy revealed the best result in the PAS-isoniszide regimen and order of
Streptomycin-isoniazide. Streptomycin-PAS-isoniazide and Streptomycin-PAS, the least
effect of all. It was also noted that the result of triple drug therapy has not particularly
better than the combined use of two drugs aforementioned. The negative conversion rate
of sputum after 12 and 24 months´ chemotherapy on ambulatory basis has been 35.8 and
47.3 percent respectively and the improvement appeared to continue even after 12
months. The roentgenologic improvement was seen in 78 and 79 percent at 12 and 24
months respectively. The continuation of chemotherapy after 12 months has not shown
any signigicant improvement on x-ray findings. However, the rate of inactivation of
disease after 12 and 24 months chemotherapy has each been 14and 26 percent, and this
continued improvement, despite the standstill situation on the X-ray, can be attriutedto
the continuing improvement in the negative conversion rate of sputum. The overall rate
of the inactivation of the long-term chemotherapy tried for the Korean pulmonary
tuberculosis patients on ambulatory basis has definitely been poorer than that of the
hospitalized patients or ambulatory patients in other advanced countries. Perhaps the
main reason of the above poorer result is the disadvantageous socio-economic factors in
this country. which do not permit these patients the necessary rest and amole
nourishment. More than half of the minimal cases(53 and 71 percent) have been
inactivated in 12 and 24 months, but the prognosis of the moderately or far advanced
patients have generally been poor. And the cure of the severe cases appears to be
almost impossible on ambulatory basis. However, the fact that 35.8 and 47.3 percent of
the open pulmonary tuberculosis cases become noninfectious in 12 and 24 months as a
result of the long-term chemotherapy seem to show the usefulness of this ambulatory
treatment from the view point of public health. In view of the limitation of ambulatory
chemotherapy, the selection of the subject had better be limited to minimal or reversible
cases. The end of 12 months´ chemotherapy appears to be and important turning point
in the re-evaluation of the patients´ prognosis whether to be remained in continued
chemotherapy, surgical intervention or other measures.
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