Therapy Comparing Chemotherapeutic Regimens in Tuberculosis Nine and 18 months' chemotherapy are equally effective in lymph node tuberculosis, , ,

In a multicentre open randomised study, 73 patients with superficial lymph node tuberculosis received rifampicin 450 or 600 mgjday + isoniazid 300 mgjday for 9 (n = 34) or 18 (39) months. All patients received ethambutol 15-25 mgjkgjday for the first 8 weeks of treatment.

At 5 years' follow-up, no relapses were observed clinically or bacteriologically and no sinus formation, scar breakdown or fluctuation in the size of nodes were reported. The cosmetic appearance of the :original site of the disease was classified as perfect in 24 patients treated for 9 months vs 27 patients treated for 18 months, as adequate in 3 vs 7, poor in 0 vs 0 and unknown in 7 vs 5 patients. Initial surgery or aspiration had no particular benefit.

'These results . .. confirm 9 months of rifampicin and Isoniazid supplemented for the first 8 weeks by ethambutol is effective for disease of superficial lymph nodes caused by Mycobacterium tuberculosis', British Thoracic Society Research Committee. British Journal of Diseases of the Chest 82: 282-284. Jul 1988

. , , but regimens with pyrazinamide are superior to those with ethambutol A retrospective study was conducted to compare the efficacy of pyrazinamide with that of

ethambutol when given in combination with rifampicin + isoniazid in the treatment of patients with tuberculous mediastinal lymphadenopathy. Patients received pyrazinamide (1 .5g for body weights <

7.74

50kg or 2g if ~ 50kg) + rifampicin (450mg if < 50kg or 600mg if ~ 50kg) + isoniazid 300mg for 2 ~onth~ follow~d by rifampicin + isoniazid for 10 months (n = 37) or ethambutol 15 mgjkg + rifampicin + ISOniaZid for 2 months followed by rifampicin + isoniazid for 10 months (32). Response was assessed from chest x-rays.

The rate of improvement was significantly better at 2, 5 and 7 months in the pyrazinamide-treated woup than in the ethambutol-treated group. Although the incidence of initial gland enlargement was s!gnlf!cantly .Iower at 2 months in pyrazinamide recipients than in ethambutol recipients, there was no significant difference between treatment groups in the degree of glandular enlargement after 1 year. No relapse occurred among the pyrazionamide recipients but 1 ethambutol recipient developed cervical tuberculous lymphadenopathy 3 years after the end of treatment.

Thus, 'this small retrospective radiological assessment shows that pyrazinamide in doses of 25-40 mg/kg gives superior results when compared with ethambutol 15 mg/kg for the initial 2 months of treatment for tuberculous mediastinal lymphadenopathy'. There are ' ... also some cost advantages to the use of pyrazinamide'. Ormerod LP. British Journal of Diseases of the Chest 82: 274-281. Jul 1988 7476

0156-2703/88/0903-0005/0$01.00/0 © ADIS Press INPHARMA® 3 Sep 1988 5