Since the advancement of anti-tuberculous chemotherapy by the development of SM,
PAS and INH, most of the active pulmonary tuberculosis have been almost successfully
treated by the combined use of three major drug, especially by a long-term
chemotherapy. However, the application of major drugs which are widely used has a
certain limitation of their actions. The emergence of bacterial resistance induced by the
long-term chemotherapy increases the number of patients whose therapeutic effect
cannot be expected from the use of ordinary drugs. Some of these cases are probably
too far progressed to be effective and the others who have become ineffective to these
drugs due to inadequte and irregular drug therapy previously. Therefore, new agents
which have no cross-resistance with the major drugs and have a stronger bacteriocidal
action have been widely sought.
Author has already discussed the clinicial effects of combined chemotherapy using
major drugs in previous chapter. This paper is to report the clinical effects of newer
anti-tuberculous agents such as Cycloserine, Nicotinaldehyde thiosemicarbasone, a
massive use of isoniazid and a combined therapy with Steroid hormone in this chapter.
The combined therapy of Cycloserine-isoniazid(10 cases), massive isoniazid therapy(10
cases), and Steroid hormone therapy (9 cases) for the relatively advanced chronic
pulmonary tuberculosis patients; and the combined therapy of Nicotinaldehyde
thiosemicarbasone-isoniazid for ten patients who have no previous chemotherapy have
been tried. A clinical study on the effect. of these treatments has been made and the
following results were obtained.
At the end of 6 months Cycloserine-isoniszid combined therapy, 3 cases out of 10
showed negative conversion of sputum and 4 cases showed improvement of the lesions
and diminution of cavity size in the X-ray findings. During the course of the treatment,
no serious side reactions have been noted and it appears that the combined use of
Cycloserine 0.5gm daily and Isoniazid can be safely employed for the ambulatory
patients.
The combined therapy of Nicotinaldehyde thiosemicarbasone-isoniazid after 6 months,
period proved to be inferior to the conventional anti-tuberculous therapy from clinical
findings, X-ray, and negative conversion rate of the sputum, during the ambulatory
treatment. The daily dosage of 300mg of this preparation has shown no marked side
reactions.
The result of the massive Isoniazid (approximately 1000mg daily) combined with
Pyridoxine hydrochloride (100mg daily) after 6 months therapy has shown only slight
improvement in the X-ray and negative conversion rate of sputum. However, there has
been a fairly marked improvement of the subjective symptoms. The peripheral
neuropaty, the anticipaed toxicit of Isoniazid, has seldom seen in the course of this
therapy.
The short-term follow-up study of Steroid hormone combined chemotherapy under the
least available chemically sheltered condition of sputum but moderate improvement in
X-ray findings. Evident appearance of the acne-type eruptions has been seen in 7 out of
9 cases as a result of the hypercortism due to Steroid hormone.
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