Trial of two intermittent short-course regimens (78 doses) in the initial treatment of pulmonary tuberculosis

A controlled trial was done in Roumania to compare 2 regimens in patients with culture-positive pulmonary tuberculosis. Both regimens were of twice-weekly doses under supervision for 9 months, a total of 78 doses. Patients were followed up for 15 months after the end of treatment. The regimens were as follows: IR, isoniazid and rifampicin for 3 months followed by isoniazid and either streptomycin or ethambutol for 6 months; ISE, isoniazid, streptomycin and ethambutol for 3 months followed by isoniazid and either streptomycin or ethambutol for 6 months. Of 128 IR cases and 104 ISE cases with sensitive cultures initially all were culture-negative at 6 months. At the end of 9 months there were 1.8% of 112 in the IR group which had had 2 positive cultures in the 6-9 month period and 3.4% of 88 in the ISE group. After 15 months from the end of treatment 5.6% of 89 in the IR group had had a bacteriological relapse and 8.9% of 79 in the ISE group. Cultures from all relapsed cases were still sensitive to the drugs used. All relapses occurred during the first 12 months. In only 5.6% of 232 patients did adverse reactions necessitate change of treatment. The efficacy, cost, tolerance and suitability of the regimens for a national programme are discussed.