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Vol. 14. Issue 3.
Pages 105-117 (July - September 1978)
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Vol. 14. Issue 3.
Pages 105-117 (July - September 1978)
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Tratamientos cortos en tuberculosis pulmonar. La evolucion conceptual de la terapeutica. 3 ensayos controlados
Short term treatments for pulmonary tuberculosis
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F.J. Guerra Sanz, R. Rey Durán, J.J. Martínez Cuesta, F. Bachiller Cabezón, L. Muñoz Cabrera, R. Salama Benoliel, L. Lara Garcia, J.J. Fernández Luceño, P. Martínez Larriba
Servicio de Bronconeumologia Clínica Torácica Victoria Eugenia Madrid
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Resumen

En Tuberculosis, hoy se trata de utilizar un régimen terapéutico tan eficaz que sea capaz de curar al enfermo antes de que se canse de tomar la medicación. Los Tratamientos Cortos con Rifampicina e Hidracida, completados con una tercera droga, son el motivo de este trabajo. Se ha realizado un Estudio Controlado en 3 fases: 1.erEstudio, de «Aproximación a los Tratamientos Cortos» de 12 meses de duración, (99 casos) en donde se ha ido acortando el tiempo de ad ministración de la Rifampicina (12,9 y 6 meses), pero manteniendo en todos los casos la Hidracida hasta completar el año de tratamiento. 2.° Estudio, con pautas abreviadas de duración real de 12. 9 y 6 meses (133 pacientes) y 3.er Estudio, todavía en fase de admisión de enfermos; donde se pretende conocer qué papel juega la Pirazinamida sobre la recidiva, y cual es su tolerancia. Hasta ahora cuenta con 157 casos.

En un régimen standar, que sirve como control la conversión del esputo se consigue al final del 6.° mes; en tanto que los que contienen R/AMP lo consiguen al 3.er mes. Entre 245 enfermos ha habido 5 fracasos bacteriológicos en el transcurso del trata-miento (2%). 3 con el régimen standard (8,5%) y 2 con los regímenes que llevan R/AMP (1%). Hasta ahora no ha habido recidiva alguna, incluso en los regímenes de 6 meses de duración, bien es cierto que el número de casos es todavía reducido para poder extraer conclusiones que tengan valor estadístico. Todavía es temprano para valorar los datos del 3. er Estudio; sólo es destacable la toxicidad a la PZ que no es despreciable, pero que podría aceptarse si esta droga fuera capaz de reducir las recidivas y recortar aún más el tratamiento.

Se hacen unas consideraciones sobre los tres sectores que componen la población bacilar de una cavidad «no tratada»: La masa bacilar sensible, los gérmenes inicialmente resistentes, y los bacilos persistentes. Se concluye que los Tratamientos Cortos actúan con eficacia sobre estas 3 subpoblaciones bacilares.

Por publicarse este trabajo en una Revista de amplia difusión entre los neumólogos españoles, gran parte de los cuales viven alejados del problema de la Tuberculosis, se intercalan más comentarios de tipo práctico de los debidos.

Summary

In Tuberculosis, today one tries to use a therapeutical regimen so effective that it is capable of curing the patient before he tires of taking the medication. Short term treatments with Rifampicine and Hidracide, completed with a third drug are the motive of this pa per. The authors have carried out a Controlled Study in 3 phases: 1st Study. of «Approximation to Short Term Treatments: 12 months long, (99 cases) where the length of time of administration of Rifampicine was shortened 12, 9 and 6 months), but maintaining in all the cases Hidracide until completing the year of treatment. 2nd Study, with abbreviated guides of real duration of 12. 9 and 6 months (133 patients). 3rd Study, still in the phase of admission of patients; where the authors pretend to learn the role of Pirazinamide on relapse, and what is its tolerance. To date, the authors count with 157 cases.

In a standard regimen, that serves as control, the conversion of sputum was achieved at the end of the 6th month; whereas those that contain R/AMP achieve this conversion in the third month. Out of a group of 245 patients there were 5 bacteriological failures during the course of treatment (5%); 3 with the standard regimen (8,5%) and 2 with the regimens that include R/AMP (1%). Up to now there has been no relapse, including the regimens of 6 months of duration. However, it is true that the number of cases is still too small to be able to offer conclusions witha statistical value. It is still early to evaluate the data of the 3rd Study; although the toxicity of PZ is worthy of note, as it is not contemptible, but could be acepted if this drug were capable of reducing the nomber of relapses and shortening the treatment even more.

The authors then comment on the three sectors that compose the bacillary population of an «untreated» cavity: the sensitive bacillary mass, initially resistant germs, and persistent bacilli. The authors come to the conclusion that the Short Term Treatments act effectively on these 3 bacillary subpopulations.

Finally the author add appropriate commentaries of a practical type as this paper is published in a journal of wide distribution among Spanish pneumologists, many of whom do not live the problem of Tuberculosis closely.

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Bibliografia
[1.]
W. Fox.
Considerations generales sur le choix et maniement des regiments therapeutiques dans la Tuberculose Pulraonaire.
Bull. Un. Intern. Con. Tub., 47 (1972), pp. 51
[2.]
A. Rouilion.
Motivation.
Bull. Un. Inter. Tub., 47 (1972), pp. 72
[3.]
F.J. Guerra Sanz, F. Rey Duran.
Criterios y normas generales sobre Quimioterapia Antituberculosa. Papel del Hospital en el tratamiento del enfe-mo tuberculoso.
BroncoNeumol., 11 (1975), pp. 91
[4.]
G. Brouet.
Collaborative study of the shrt-term antibacillary treatment in 14 centers.
Bull. Un. Inter. Con. Tub., 49 (1974), pp. 369
[5.]
G. Canetti, Ph. Gay, M. Le Lirzin.
Trends in the prevalence of primary resístame in pulmonary tuberculosis in France from 1962 to 1970: a national survey.
Tubercle, 53 (1972), pp. 57
[6.]
B. Doster, G.J. Caras, D.E. Snider.
A continuing survey of primary resistance in tuberculosis. 1961 to 1968.
Am. Rev. Resp. Dis., 113 (1976), pp. 419
[7.]
A. Gyselen, L. Verbist, F. Simonpouthier, A. Brabandre.
La rifampicina dans le traitment d’attaque de la tuberculose Pulmonaire.
Rev. Tubero. Pneum., 33 (1969), pp. 133
[8.]
First International Tuberculosis Chemotherapy Study In Czecpioslovakia.
A comparative study of daily and twicvv weekly continuation regi mens of tuberculosis chemotherapy, including a comparison of two durations of sanatorium treatments.
Bull. Wld. Hlth. Org., 45 (1971), pp. 573
[9.]
D.E. Poppe, F. Figueiredo, A. Alves Brito, J.H. Laborne Valle, P. Martin Tavares, P. Linhares Trannin.
Short duration chemotherapy for pulmonary tuberculosis. A pilot trial.
Bull. Un. Int. Con. Tub., 49 (1974), pp. 382
[10.]
East African/British Medical Research Councils.
Controlled clinical trial of four short-course (6-month) regimens of chenotherapy for treatment of pulmonary tuberculosis.
Lancet, 1 (1972), pp. 1081
[11.]
East African/British Medical Researchcouncils.
Controlled clinical trial of four short-course (6-month) regimens of chemotherapy for treatment of pulmonary tuberculosis. Second report.
Lancet, 1 (1973), pp. 1331
[12.]
East African/British Medical Research Councils.
Controlled clinical trial of four short-course (6-month) regimens of chemotherapy for treatment of pulmonary tuberculosis. Third report.
Lancet, 2 (1974), pp. 237
[13.]
British Ihoracic And Tuberculosis Association.
Short-course chemotherapy in pulmonary tuberculosis.
[14.]
W. Fox, D.A. Mitchison.
Chemotherapy for pulmonary tuberculosis.
Am. Rev. Resp. Dis., 115 (1977), pp. 717
[15.]
D.A. Foxw Mitchison.
Shortcourse chemotherapy for pulmonary tuberculosis.
Am. Rev. Resp. Dis., 111 (1975), pp. 325
[16.]
East African/British Medical Research Councilstudy.
Results at 5 years of a controlled comparison of a 6-month and standard 18-month regimen of chemotherapy for pulmonary tuberculosis.
Am. Rev. Resp. Dis., 116 (1977), pp. 3
[17.]
G. Brouet, G. Roussel.
Rapport general. Essai 6.9.12. Méthodologie globale et synthésc des resultats.
Rev. Fran. Mal. Resp, 6 (1977), pp. 5
[18.]
GUERRA SANZ, F.J., REY DURAN, R., MARTINEZ CUESTA, J.J., LARA GARCIA, L., MUÑOZ CABRERA; L., SALAMA BENO-LIEL, R. y MARTINEZ de la RIVA.: clinical approach to short-treatment in pulmonary tuberculosis. Excerpta Medica. En prensa. ;1; in press.
[19.]
Hong Kong Tuberculosis Treatment Services/British Medical Research Counciis.
Adverse reactions to short-course regimens containing streptomycin, isoniazid, pyrazinamide and rifampicin in Hong Kong.
Tubercle, 57 (1976), pp. 81
[20.]
G.A. Eliard, R.M. Haslam.
Observations on the reduction of the renal elimination of urate in man caused by adminlstration of pyrazinamide.
Tubercle, 57 (1976), pp. 97
[21.]
F.J. Guerra Sanz.
Side effects during intermittent rifempicin and ethambutol treatment. A preliminary report.
Scand. J. Resp. Dis. Suppl., 84 (1973), pp. 160
[22.]
F.J. Guerra Sanz, J.J. Martinez Cuesta.
A preliminary report of the results and side effeets obtained during retreatment of pulmonary tuberculosis with intermittent rifampicin and ethambutol regimens.
Rifampicin, pp. 56
[23.]
E. Regli Fernandez, F. Bachiller Cabezon, SANTOS De Cossio, J.L. Lopez Sendon, A. Gaton Roson, A. Martinez Cuervo, E. Gallego Gonzalez, R. Rey Duran, F.J. Guerra Sanz.
Intolerancias en el curso de un tratamiento con rifampicina y ethambutol.
En: Symposium Mediterráneo de Tisiología, Lepetit, (1974), pp. 93
[24.]
G. Canetti.
Present aspect of bacterial resistance in tuberculosis.
Am. Rev. Resp. Dis, 92 (1965), pp. 687
[25.]
W. Fox.
The scope of controlled clinical trial, ilustrated by studies of pulmonary tuberculosis.
. Bull. Wld. Hlth. Org., 45 (1971), pp. 559
[26.]
C. Evans, W. Fox, P.R.S. Gangadharan, N.K. Menon, S. Ramakriohnan, H. Stott, S. Velu.
A 5 year study of patients treated at home in a controlled comparison of isoniazid plus Pas with 3 regimens of isoniazid alone.
Bull. Wld. Hlth. Org., 11 (1969), pp. 1
[27.]
Madras Tuberculosis Chemotherapy Centre.
A current comparison of intermittent (twice weekly) isoniazid plus streptomycin-an dayly isoniazid plus Pas in domicilian treatment.
Bull. Wld. Hlth. Org., 31 (1964), pp. 247
[28.]
East African/British Medical Research Council.
Comparative trial of isoniazid alone in low and higth dose, and isoniazid plus Pas in the treatment of acute Pulmonary Tuberculosis in East Atricans.
Tubercle., 41 (1960), pp. 83
[29.]
Madras Tuberculosis Chemotherapy Centre.
Isoniazid plus thiacetazone compared with two regimens of isoniazid plus Pas in the domiciliary treatment of pulmonary tuberculosis in south patients.
Bull. Wld. Hlth. Org., 34 (1966), pp. 483
[30.]
East African/British Medial Research Council.
Isoniazid with thiocetazone in the treatment of pulmonary tuberculosis in East Africa. Fifth investigation. Second report.
Tubercle., 51 (1970), pp. 353
[31.]
East African/British Medical Research Councils.
Isoniazid with thiacetazone in the treatment of pulmonary tuberculosis in East Africa. Fifth Investigation. Third report.
Tubercle., 54 (1973), pp. 169
[32.]
Singapore Tuberculosis Services/Brompton Hospital/British Medical Research. Council Investigation.
A controlled clical trial of the role of thiacetazone containing regimens in the treatment of pulmonary tuberculosis in Singapore.
Tubercle., 52 (1971), pp. 88
[33.]
Singapore Tuberculosis Services/Brompton Hospital/British Me Dical Research Council Investigaron.
A controlled clinical trial of the role of thiacetazone containing regimens in the treatment of pulmonary tuberculosis in Singapore. Second report.
Tubercle, 55 (1974), pp. 251
[34.]
British Medical Research Councils.
Long-term chemotherapy in the treatment of chronic pulmonary tuberculosis with cavitation.
Tubercle, 43 (1962), pp. 201
[35.]
V. Nitti, E. Catena, F. Delli Veneri, G. De Michele, A. Marra.
Rifampicin in association with isoniazid, streptomycin and ethambutol, respectivily, in the initial treatment of pulmonary tuberculosis.
Am. Rev. Resp. Dis., 103 (1971), pp. 329
[36.]
British Medical Research Councils.
Co-operative controlled trial of a standard regimen of streptomycin. Pas, and isoniazid and three alternative regimen of chemotherapy in Britain.
Tubercle, 54 (1973), pp. 99
[37.]
J.B. Selkon, S. Devadatta, K.G. Kul Karni, D.A. Mitchison, A.S.L. Narayama, K. Ramachandran.
The emergence of isoniazid-resistant cultures in patients with pulmonary tuberculosis during treatment with isoniazid alone or isoniazid plus Pas.
. Bull. Wld. Hlth. Orq., 31 (1964), pp. 273
[38.]
F.J. Guerra Sanz.
Tratamiento actual de la Tuberculosis Pulmonar Abierta.
Editor: Publicaciones Lederle, (1969),
[39.]
Hong Kong Chest Service/British Medical Research Council.
Controlled trial of 6-month and 9-month regimens of dayly and intermitent streptomy cin plus isoniazid plus pyrazinamide for pulmonary tuberculosis in Hong Kong. The results up to 30 month.
Am. Rev. Resp. Dis., 115 (1977), pp. 3
[40.]
F. Grumbach, J. Grosset.
La pirazinamide dans le traitment de courte durée de la tuberculose murine.
Rev. Fr. Mal Resp., 3 (1975), pp. 5
Copyright © 1978. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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