The Use of the Iso-nicotinic Acid Hydrazides in the Treatment of Tuberculosis

¹ The Department of Medicine, The Tulane University School of Medicine and the Charity Hospital of Louisiana at New Orleans.

Fifty patients with various forms of tuberculosis were treated with isoniazid or its isopropyl derivative, for periods ranging up to eight months. With few exceptions, 4 mgm. per kgm. of body weight of either drug was administered daily. After an interval of one to two months in which the early response to the drug was determined, streptomycin or PAS was added to the treatment regimen.

An excellent early systemic response to the drugs was generally noted. In acute pneumonic cases, cough and sputum were sharply reduced and striking resolution was reflected by roentgenograms. A number of more chronic pulmonary cases showed considerable improvement; cough and sputum decreased, and cavities became smaller. Those with serous membrane involvement soon became afebrile and effusions disappeared without repeated aspirations. In meningitis, clinical improvement and favorable spinal fluid changes occurred. The closure of sinuses leading to bone lesions and the resorption of subcutaneous cold abcesses were observed.

Toxic reactions were mild. In three instances treatment was suspended because of dizziness and muscular twitching but was uneventfully reinstituted. One patient was obliged to discontinue iproniazid because of dermatitis but was able satisfactorily to substitute isoniazid. Increased deep reflexes were noted in most cases.

Because clinical improvement has been maintained in the great majority of cases after the addition of streptomycin or para-aminosalicylic acid, it is suggested that the development of resistant tubercle bacilli (previously demonstrated by others to occur within two months after starting therapy with isoniazid) may be deferred and therapeutic effectiveness prolonged by combined antibiotic therapy.