ADVERSE SURGICAL EXPERIENCE IN THE TREATMENT OF PULMONARY DISEASE CAUSED BY ATYPICAL ACID-FAST, BACILLI

Treatment of pulmonary disease caused by opportunist mycobacteria

Opportunist mycobacterial infections localised to the chest may be treated with combinations of standard antimycobacterial drugs. The combination of rifampicin and ethambutol seems to be particularly effective, both in vivo and in vitro. In vitro sensitivity testing with single drugs may have a role in the future when the levels of in vitro resistance compatible with the clinical response to treatment are eventually established. Sensitivity testing against drugs in combination may prove useful for modifying treatment regimens in those patients who either fail to respond to initial chemotherapy or relapse. Further evidence on this will, it is hoped, emerge from the prospective studies currently in progress.

Treatment of unclassified mycobacterial infection of the lungs

In a review of 25 patients with pulmonary infection caused by unclassified mycobacteria the course of the disease is related to the method of treatment. Five patients were followed while not being treated; in four the disease progressed and in one it remained static, and in each case the organism persisted in the sputum. Sixteen patients were given combinations of streptomycin, isoniazid, and para-aminosalicylic acid for periods which varied between three months and two and a half years; there was bacteriological sputum conversion in six, although in each case the organism showed in vitro resistance to these drugs. Eleven patients were treated primarily with combinations of other anti-tuberculosis drugs for at least 12 consecutive weeks, after which the mycobacteria could no longer be cultured from the sputum in eight, in each case the organism showing in vitro sensitivity to the drugs. Ten patients received combined medical and surgical treatment, which was successful in eight and a failure in two, one of whom died post-operatively. A favourable response occurred most frequently when the disease was confined to one pulmonary radiographic zone and when less than 10 positive sputum cultures had been obtained. These results show that in this type of disease the response to chemotherapy is uncertain, in vitro drug sensitivity tests are of limited value, and combined medical and surgical treatment is usually effective.