[Management of INH and RFP-resistant refractory tuberculosis]

Two issues are to be taken into consideration when we deal with the management of refractory tuberculosis in which bacilli are resistant to both INH and RFP, two major drugs in tuberculosis chemotherapy. One is how to treat such refractory TB cases and another issue is how to prevent the spread of such drug-resistant bacilli into the environment of the patients. In this symposium, therefore, they discussed on either of these two points. On the first issue of the problem, how to treat the refractory TB, Dr. Ikeda reported that chronic, bacilli-positive cases with long duration of chemotherapy showed poor prognosis, often fatal because they were usually resistant to other drugs, too, in addition to INH and RFP, whereas some cases in which no prior chemotherapy was conducted responded to ordinary regimen including INH and RFP. Dr. Ikeda recommended the use of ofloxacin for the treatment of INH and RFP--resistant TB. Ofloxacin, according to his study, was effective and kept bacilli free for more than 6 months in 15.7% of refractory cases. Dr. Masuda analyzed the factors which were responsible for the failure of treatment in INH and RFP-resistant cases. Most of the treatment failure cases, he observed, belonged to the severe cases, of which the chest x-graph revealed deviation of trachea, thickened pleural wall and multiple cavities composed of cirrhotic walls. His conclusion was that, as soon as both INH and RFP was shown ineffective, the regimen should be throughly changed with other drugs. Surgical treatment should also be taken into consideration. On the second issue of the problem, that is, how to prevent the spread of drug-resistant bacilli, Dr. Ikari described on his study of family investigation conducted in Aichi Prefecture. According to his report, the frequency of INH and RFP-resistant TB cases were not so high. However, treatment of drug-resistant cases at home sometimes led to the development of new TB cases among the family, that is infection in children and grandchildren whose bacilli were also found resistant to INH and RFP. He insisted the necessity of treatment of such cases isolated in hospital.(ABSTRACT TRUNCATED AT 250 WORDS)