Critical Concentration of the Secondary Drug Resistance
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As there is no unanimous coincidence of opinions about the critical concentration of the secondary drug resistance, we have studied on 251 cases of severe pulmonary tuberculosis, who were always discharging the tubercle bacilli and became almost all resistant to the primary drugs.The resistance test was carried out on 3% Ogawa medium containing the drug of concentration 0, 50γ, 100γ, 1000γ for kanamycin (KM), 0, 25γ. 50γ, 100γ for Ethionamide (TH) or cycloserin (Cs). Although the absorption of KM by egg medium was shown by many authors, we didn't think that it was necessary to know the true value of the drug in the medium in connection with resistance test. Moreover we experienced better coincidence of resistance grade by the Ogawa medium than by the agar medium, when the study was executed in 24 different institutes on 10 different tubercle bacilli stems at the same time. The size of the inoculum was about 10-3mg, but the growth on the control was not necessarily the same. The value of Cs or TH in the Ogawa medium decreases with the prolongation of the preservation days, the higher the temperature, the more it was damaged rapidly. From this study, we used the media at least within two weeks after they were made.Among the patients who didn't yet receive the secondary drugs, the sensitive cases to 25γ were found in 51.5% for TH, and in 48% for Cs. The cases to sensitive to 50γ were found in 91.5γ for KM, in 83.7% for TH and in 82% for Cs. Accordingly we adopted any growth on 50γ as a critical concentration of the secondary drug for the present, although the resistance grade of one patient was not necessarily the same during the course of the treatment, even if he didn't receive any of the secondary drugs.The conversion rate was parallel to the grade of the lung destruction, and the number of discharged bacilli, It was better when the patient was treated with combined two or more secondary drugs than with only one drug, in latter cases, the primary drugs became already resistant, were always combined.The conversion rate of 89 cases treated with one of the secondary drugs which were sensitive to 50γ, was 16%, on the other hand that of 27 cases resistant to the drug was only 7%.Among the cases treated with combined two secondary drugs, in 48 cases sensitive to 50γ the conversion rate was 41%, in 20 cases resistant to one drug it was 30%. and in 6 cases all resistant it was only 16%. The period of the appearance of the resistance was eariest with TH. and slowest with Cs.There were several cases who didn't become resistant to 50γ, when the bacilli of sputum inrceased again, after they became negative or decreased. This means that the critical concentration of the secondary drugs could be lower in these cases,
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
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