Treatment of short course chemotherapy [SHRZE] failure cases with kanamycin, ethionamide and cycloserine

To determine the effectiveness of reserve regimen 93Kon, Eth and Cyc+9Eth and Cyc] with regard to bacteriological conversion, relapse and side-effects. Design: Prospective study of 32 CHRZE treatment failure cases of pulmonary tuberculosis. Setting: Private ward, Institute of Chest Diseases, Kotri. Subjects: Thirty two cases of pulmonary tuberculosis, average age 33 years [ +/- SD 9.2] on retreatment regimen [SHRZE] for an average duration of 7.03 [ +/- SD 4.08] months who remained positive for AFB in their sputa on direct microscopy and culture. Among 26 patients who completed the initial phase, 20 [76.9%] showed sputum conversion on smear microscopy and culture at three months. the mean duration of sputum conversion was 44.9 [SD +/- 24.1] days. Following completion of chemotherapy in 23 patients, 18 [78.2%] remained smear and culture negative at the end of one year. The treatment failure rate during the initial protocol was 22% and relapse rate after one year of post-chemotherapy follow-up was 5.5%. Besides four serious toxicities, all the adverse effects were manageable. The default rate also remained high [22%] because of high cost. Conclusions: For patients with multidrug resistance, the reserve regimen is an effective alternative therapy with manageable side-effects

Short course chemotherapy with steroids in pulmonary tuberculosis: a preliminary report

In a prospective study at our Institute a total of 255 cases of sputum positive pulmonary tuberculosis with varying extent of disease on chest X-ray and not having any contra-indication for steroids were analysed by keeping 124 patients alone on 2SHRZ / 2HRZE + 6HE as control while 131 on 2SHRZ / 2HRZE + 6HE and steroids [Dexamethasone 6mg] as study group. The 20 months follow-up showed steroids as an adjunct to short course chemotherapy produces more rapid symptomatic relief, earlier sputum conversion, rapid clearing of pulmonary infiltrates and high rate of cavitary reduction or closure on chest radiographs. Greater radiographic clearing [P<0.001] with minimum residual shadows and improved breathlessness [P<0.05] in steroid treated patients reflect on minimum scarring and subsequent improvement in lung functions