The Treatment of Pulmonary Tuberculosis with Isonicotinic Acid Hydrazide

¹ The University Clinic of Phthisiology, Sanatorium "Sotiria".

1) Serious toxic reactions have not been seen by the use of these new drugs in a dosage of 4 to 5 mg. per Kg. of body weight.

2) With the administration of these compounds no clinical unfavorable influence was observed.

3) The temperature, the toxic symptoms, as appetite, fatigues, sweats as well as the general condition of the patients were favorably influenced from the first days of treatment.

4) The more elevated the temperature the more favorably it is influenced. So, within three to six days the temperature fell by crisis to normal limits or remained at a lower degree, while slight fever was hardly influenced.

5) It was impressive how appetite was regained, reaching in certain cases the limits of ravenousness.

6) We have been impressed by the fact that patients of bad prognosis confined permanently to bed on account of their severe toxic condition got out of bed and strolled around the clinic.

7) Intense cough was greatly influenced. The incessant cough of one patient not influenced by the common drugs, gradually diminished and finally disappeared.

8) Expectoration decreased in half of our cases. It is interesting to notice that, the more copious the sputum previously was, the more reduced it became.

9) Unfortunately amelioration in the general condition and symptoms of the patients was not followed by adequate improvement in the auscultatory findings except in two cases.

10) Satisfactory x-ray film modification was not observed. In nine cases it consisted of considerable reduction or complete disappearance of the pericavitary and perifocal shadows. The foci themselves were not influenced. In a few cases only the existing cavities became smaller. In certain cases roentgenograms taken after the treatment showed disappearance of preexisting cavities. But tomography taken afterwards demonstrated that cavities existed as before.

11) It is interesting to note that in nine cases despite the clinical amelioration after a one and one-half to two months treatment, a relapse occurred and consequently all the toxic symptoms reappeared. In eight of these cases the focal process remained stationary and in one, deteriorated. Consequently, in a certain number of cases, the administration of the new drugs did not manage to stop the further evolution of the disease despite the temporary amelioration: four of these nine patients died. Intense toxic symptoms in certain cases were considerably diminished.

In case of primary infection, the new drugs must be administered with the maximum dosage daily (4-5-7-10 mg. per Kg. body weight) for one to three months, until the morbid symptoms disappear. Afterwards, the administration of streptomycin must follow (three times a week) in a total quantity of 15-20-30-40-50 Gm. while simultaneously PAS is given per os, long after streptomycin is discontinued.

In case of chronic tuberculosis associated with intense toxic symptoms, the hydrazides must be administered in order to reduce or make the toxic symptoms disappear. On the other hand, the administration of the new drugs in cases of chronic tuberculosis without toxic symptoms is useless.

When collapse therapy in certain cases of chronic tuberculosis is indicated, it should not be postponed or replaced by the new drugs. We do not know yet whether the administration of 10 mg. per Kg. of body weight per day instead of 4 to 5 mg. of isonicotinic acid hydrazide might give us better results, especially in focal processes.