Massive Intravenous Therapy as Initial Treatment in Tuberculosis

¹ Department of Medicine, Harlem Hospital, Department of Hospitals, City of New York
² Department of Medicine, Harlem Hospital, Department of Hospitals, City of New York, Director of Medicine

To solve the many problems of conventional antituberculosis therapy, we adopted, after Herzog's method, a technique of initial intravenous treatment. Through a catheter in a brachial vein we administer a constant intravenous drip of a dihydrostreptomycin pantothenate-PAS-INH-heparin mixture for a six-week period. Precautions are taken against thrombosis, PAS decomposition, and hemorrhagic diathesis. There are no other hazards. Forty-two patients have been successfully treated by this method since 1958 with clinical and bacteriologic remission within two weeks. Hospitalization was reduced to three months and total therapy time to one year. The efficacy of this treatment depends on sustained optimal tissue levels of the three antimicrobials used and probably on a stabilizing interplay among the antimicrobials and heparin. This type of treatment should be especially suitable in high incidence tuberculosis areas and could possibly be combined with collapse therapy in cavitary disease where resectional facilities are limited.