Pulmonary Resection for Tuberculosis Under Protection of Viomycin, Promizole and Pyrazinamide

¹ The Departments of Surgery, Mississippi State Sanatorium and University of Mississippi Medical Center.

1) An analysis is presented of the temporary protection of viomycin combined with promizole or pyrazinamide in 35 pulmonary resections in 32 patients with open positive tuberculous lesions. In each, the tubercle bacilli were proved or presumptively resistant to streptomycin, PAS, and isoniazid.

2. The failure of previous medical therapy was found to be explained by mechanical factors which would prevent cavity closure regardless of the nature or duration of medical therapy.

3) There were four deaths unrelated to drug coverage. There has been no spread, bronchopleural fistula or empyema. Two patients had early and one a late reactivation. Three additional patients demonstrated late bacteriologic relapses, but have subsequently been negative over a year. Thus, of 28 survivors followed from six to 36 months, 22 have never shown postoperative activity and 26 may now be classified as arrested or inactive.

4) Viomycin combined with either promizole or pyrazinamide appears to offer satisfactory temporary protection for excisional surgery in tuberculosis. Nonetheless, promizole has not been used since the availability of the more potent pyrazinamide.