A STUDY ON THE PREVALENCE OF PRIMARY DRUG RESISTANCE AMONG PULMONARY TUBERCULOUS PATIENTS OBSERVED DURING THE PERIOD FROM 1955 TO 1963:Analysis on the Factors Affecting the Prevalence Rate

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A study was made on the prevalence of primary drug resistance for major 3 anti-tuberculous, drugs among 838 cases of pulmonary tuberculosis without any previous history of chemotherapy observed during the period from 1955 to 1963. Cases were collected from 2 sanatoria and 3 dispensaries belonging to the Japan Anti-tuberculosis Association in Tokyo. Drug sensitivity was tested indirectly among 792 cases, and directly among 46 cases. The latter was used among smear positive cases. Most of the drug sensitivity test was performed. indirectly by inoculating the suspension prepared from the isolation culture of sputum, laryngeal swab or gastric lavage. Amount of inoculated bacilli was 10-1mg up to 1957, and 10-1mg since 1958. Concentration of drugs in media before coagulation was as follows: SM 20 and 200 mcg/ml, PAS 1 and 10 mcg/ml, and INH 0.1, 1 and 5 mcg/ml. In the case of SM, approximately half was absorbed by the medium, and the results of sensitivity test on SM was demonstrated finally as 10 and 100mcg/ml respectively. 3% Ogawa's egg medium was used for direct method, and. 1% Ogawa's egg medium was used for indirect method. Criteria of resistance was shown in Table 1, and the results were summarized as follows: 1. The number of primary drug resistant cases was 109, and the rate to the total cases was 13.0%. 2. The rate during the period from 1955 to 1957 was 24.0%, and was significantly higher than the rate during the period from 1958 to 1963 (9.9%). Since 1958, no marked difference was observed among the rates in the recent 6 years. 3. The rate of resistance to each drug was shown in Table 2. The rates for SM and PAS was nearly the same, and the rate for INH was approximately one third of the rates for SM and PAS. If the level of drug resistance for INH was lowered to include the cases completely resistant to 0.1mcg/ml or incompletely resistant to 0.1 and 1mcg/ml, the rates for INH during the period from to 1958 to 1963 increased to 9.1, 5.6, 4.1, 6.5, 4.5 and 4.3% respectively, which were nearly the same to the rates of resistance for SM and PAS. 4. Among many factors, sex, previous history of BCG vaccination, kinds of specimens tested, and the amount of bacilli growth on isolation culture gave no influence on the rate of primary drug resistance. The rate was slightly higher among younger cases, recently converted cases, avitary cases and more extensive cases than among older cases, previously converted cases, non-cavitary cases and slight ceses, raspectively. 5. The most marked difference in the rate of resistant cases was observed by the amount of bacilli growth on the control media. As shown in Table 3, the rate increased with the increase of bacilli growth on the control media, and the rate of # group was markedly higher than the other 3 groups. Comparing the rate of # group by the period, the rate during the period from 1955 to 1957 was significantly higher than that from 1958 to 1963. This difference was explained by the difference in the amount of inoculum, and 10-1mg inoculation is considered to be inadequate to determine the primary drug resistance. 6. Cases completely resistant to 5mcg/ml INH was observed in 2 cases.
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A STUDY ON THE PREVALENCE OF PRIMARY DRUG RESISTANCE AMONG PULMONARY TUBERCULOUS PATIENTS OBSERVED DURING THE PERIOD FROM 1955 TO 1963:Analysis on the Factors Affecting the Prevalence Rate

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