Rifampim-combined chemotherapy in coal worker's pneumoconio-tuberculosis

Results of a retrospective study of rifampin-combined chemotherapy in 59 coal miners with pneumoconio-tuberculosis are reported. In 43 patients pneumoconiosis had attained the stage of progressive massive fibrosis. The follow-up period ranged from 24 to 78 months, except in 8 patients who died before the twenty-fourth month. Twenty-seven of the 59 patients were treated for the first time, and 32 were in retreatment. In none of them had rifampin been administered before. Although the objective was to administer rifampin in combination with one, 2, or even 3 companion drugs that had not been administered before and that had proved to be active on the patients' bacilli in vitro, this goal was fully reached only in the first treatment group; in 8 of the 32 retreated patients the drugs combined with rifampin were considered ineffective. The speed and rate of bacteriologic conversion were most impressive. Sputum conversion was obtained in 90 per cent of the patients; in the initial treatment group 100 per cent of the patients converted their sputum on culture at 5 months and in the retreatment group the corresponding figure was 84.4 per cent. These bacteriologic results are nearly as favorable as those obtained in cases of advanced pulmonary tuberculosis without pneumoconiosis treated with the same rifampin-containing drug regimens. It was concluded that rifampin-combined chemotherapy largely eliminates the handicap caused by the coexistence of tuberculosis and pneumoconiosis. Side effects due to rifampin were without practical significance. In 3 patients of 57 treated with ethambutol, visual impairment was observed. Mortality was high (27 per cent) but was caused by nontuberculous diseases, especially cardiorespiratory insufficiency. In 10 of the 16 patients who died, death occurred after bacteriologic conversion.