Tuberculosis in Oriental immigrants: a study in military dependents.

Tuberculosis in Oriental immigrants is likely to be resistant to therapy with certain drugs. In 73 military dependents with positive cultures for tuberculosis who immigrated from six Asian countries, the tuberculosis was found to be resistant to isoniazid in 58 percent (42 patients), to streptomycin in 36 percent (26 patients), to p-amino-salicylic acid in 14 percent (ten patients), to rifampin in 7 percent (five patients), and to ethambutol in 7 percent (five patients). Despite the presence of drug-resistant organisms and often extensive disease, negative cultures were attained in all but one patient. Consideration of the high incidence of drug-resistant tuberculosis should be made in planning a program of treatment for these patients. Recognition of cultural differences may also be of value in the successful treatment of this difficult group of patients.

Treatment of tuberculosis by the nonpulmonary physician.

Because tuberculosis is currently being treated in many instances by the nonpulmonary physician, an evaluation of the skill with which he performs in this capacity was made. A group of 130 patients who had been treated by such physicians was analyzed, using generally accepted criteria for appropriate therapy. Seventy-three of the group were found to have been treated inappropriately. The use of isoniazid in those likely to be resistant to that drug, the use of a single drug in bacteriologically positive disease, and inadequate or excessive drug dosages were among the more common errors. Two thirds of the physicians caring for these patients were internal medicine specialists, half of them board certified. Increased education efforts in regard to this disease at all levels of training must be made.