Treatment of 171 Patients with Pulmonary Tuberculosis Resistant to Isoniazid and Rifampin

• Published in: The New England journal of medicine Vol. 328; no. 8; pp. 527 - 532
• Main Authors: Goble, Marian, Iseman, Michael D, Madsen, Lorie A, Waite, Dennis, Ackerson, Lynn, Horsburgh, C. Robert
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 25.02.1993
• Subjects: Adolescent; Adult; Aged; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial agents; Antitubercular Agents - therapeutic use; Bacilli; Biological and medical sciences; Chemotherapy; Drug dosages; Drug resistance; Drug Resistance, Microbial; Epidemics; Female; HIV; Hospitals; Human immunodeficiency virus; Humans; Immunology; Isoniazid; Isoniazid - pharmacology; Lung diseases; Male; Medical sciences; Middle Aged; Multidrug resistance; Multivariate Analysis; Mycobacterium tuberculosis; Mycobacterium tuberculosis - drug effects; Patients; Pharmacology. Drug treatments; Public health; Recurrence; Retrospective Studies; Rifampin; Rifampin - pharmacology; Sex ratio; Sputum; Sputum - microbiology; Tuberculosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - mortality; United States > US; Human; Respiratory disease; Lung; Mycobacterial infection; Infection; Antibiotic; Chemotherapy; Treatment; Tuberculosis; Mycobacterium tuberculosis; Mycobacteriales; Bacteriosis; Mycobacteriaceae; Bacteria; Actinomycetes; Antituberculous agent; Negative therapeutic reaction
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199302253280802

Modern chemotherapy, appropriately prescribed and administered, cures 98 to 99 percent of cases of previously untreated pulmonary tuberculosis if the disease is caused by drug-susceptible Mycobacterium tuberculosis 1 . Tubercle bacilli not previously exposed to antituberculosis drugs may manifest drug resistance as a result of random mutation 2 . Whereas such resistance can be overcome by appropriate multiple-drug regimens, inadequate antimicrobial therapy can lead to the emergence of drug-resistant strains. These resistant bacilli can in turn be passed on to previously uninfected persons, who may subsequently contract tuberculosis that is initially drug-resistant. Early in the chemotherapeutic era, 1 to 3 percent of . . .