[Therapeutic approaches in diseases caused by mycobacteria]

Following the historical introduction (the review by Schlossberger, 1928) the evolution of individual chemotherapy phases is briefly discussed. Then after following points are discussed. 1) The usual controlled clinical trials for evaluation of new drugs must be replaced (perhaps by estimates of the "early bactericidal activity" and of the 2 months' sputum conversion rates). 2) Interesting and of importance are research activities connected with the reasons for properties of TB bacilli in the persistence state, and of drugs capable to combat such bacilli (metronidazole?). 3) Since the human immunity against TB normally operates well (from 100 infected approximately 10 will get a clinically manifest disease), it is necessary to investigate possible combinations of chemo- and immunotherapy, either of combinations of antituberculous and immunomodulating drugs (eg. TNF alpha-antagonists), or of chemotherapy combined with vaccination (eg. M. vaccae). 4) There are still unsolved problems in formulations of drugs (particularly R in fixed combinations) and of drug resorption (in HIV-pos. patients). 5) Other points of research interest could be the adsorption of TB bacilli on the surface of mammalian cells (1st step in pathogenesis), drugs other than antituberculotics (eg. amoxycillin + clavulanic acid), or even drugs used for completely other diseases (eg. antidepressive). 6) All these attempts should serve primarily the purpose of further reduction of the necessary therapy duration (M+ pulmonary TB) to 1 - 2 months in total.