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Chemotherapy of tuberculosis
Tubercle, Lond., (1964), 45, 392
392
LETTER
T H I A C E T A Z O N E IN BRITISH PATIENTS Since my original communication (Tubercle, 1964, 45, 188) there have been two more toxic episodes with this drug regime. Ore of the thirteen original patients, wl~o was aged 78, intolerant of PAS and had had nine months of uneventful treatment, suddenly developed a severe generalized exfoliative dermatitis, with oedema and severe malaise. The eosinophils numbered 26~, of 10,000 white cells. A test dose of thiacetazone, but not of isoniazid, caused it brisk exacerbation of the rash, which slowly subsided with the administration of steroids. Two more patients have been given thiacetazone and isoniazid. One, a woman aged 29, had severe reactions to PAS and streptomycin. Five weeks after starting thiacetazone and isoniazid, the S.G.P.T. suddenly rose to 122 Reitman-Frankel units. The drugs were stopped but ten weeks later the S.G.P.T. is still 82 units. The second patient was completely intolerant of PAS and ethionamide and had cultures resistant to streptomycin and pyrazinamide: he has taken thiacetazone and isoniazid without intoward effects for five months and now has negative cultures. Over half (8) of the 15 patients treated with thiacetazone and isoniazid have had serious sideeffects. Where a companion drug for isoniazid is required other than PAS or streptomycin, it would be advisable to use less toxic drugs such as ethionamide first. In British patients, thiacetazone should be given only when ethionamide in sufficient dose cannot be tolerated, and always with regular examinations of the blood.
Ware Park Hospital, Ware, Hefts.
A. PINES
BOOK
REVIEWS
Chemotherapy of Tuberculosis. Ed. by V. C. BARRY,Butterworths, London, 1964. Pp. 281. s
19 6d.
There is no more important aspect of the control of tuberculosis than the correct application of chemotherapy. With the increasing number of patients who secrete drug resistant organisms and the appearance of numbers of anti-tuberculosis drugs 'secondary' to streptomycin, PAS and isoniazid, cb,emotherapy has however become increasingly difficult. Few modern textbooks on tuberculosis deal with the subject adequately and the reader can only turn to medical journals for help. These, though useful, can at best provide only a fragmentary picture. This book is therefo're greatly to be welcomed, it gives to the application ofanti-tuberculosis drugs the sort of pre-eminence once occupied by pathology, epidemiology and, later, surgery, it appears none too soon. The current estimate of 15,000,000 persons throughout tile world suffering from tuberculosis is probably conservative, and it is doubtful whether, as drug resistance becomes more widespread, the disease will be conquered without further new drugs. This book is well written. A group of eleven doctors from Western Europe each contribute a chapter. Their purpose, as the editor remarks in a helpful preface, has been to contribute chapters on the present state of each subject rather than review articles. As a result a volume has emerged
BOOK REVIEWS
393
wllich is probably the most authoritative as well as the most practical yet to appear on the subject. It is a mine of information, but like many mines, requires hard work to obtain a good yield. This is a reflection on the complexity of the topic, not the clarity of the writing; for this is excellent. The book opens with a chapter by two Frencll professors of biochemistry--Asselineau and Lederer. One on bacterial pathogenicity and cl'temotherapy follows from Bloch of Switzerland. Barry, of the Medical Research Council of Ireland discusses the development of chemotherapeutic agents. Meissner of Germany, writes on the bacteriology of the tubercle bacillus, and Winder of Ireland follows with a chapter on the antibacterial action of streptomycin, isoniazid and PAS. Conalty, also from the Medical Research Council of Ireland, contributes a chapter on the pre-clinical evaluation of anti-tuberculosis drugs. Canetti and Rist have written valuable chapters on host factors, and drug resistance. All these contributions lead naturally to the final two chapters ~ t h e clinical evaluation of anti-tuberculous drugs by Crofton and the current states of chemotherapy in practice by Bignall. Though only 281 pages, this book is an almost complete review of the subject, containing well over one thousand references, and lacking only a chapter on pharmacology (through no fault of the editor), it is likely to command a wide readership in the field of tuberculous disease, perhaps as much amongst tl~ose engaged in research as in clinical practice. Most scientific work profits by the pursuit of informed 'launches'. The brief section, a single page, on trends in future development of chemotherapy, which concludes the book, will provide research workers and others with. as much guidance to the future as any more lengthy contribution by those, who like all of us in the field of tuberculous disease, can only feel that we 'see in a glass darkly'.
Some Aspects of Chronic Bronchitis. By F. A. H. SIMMONDSand L. B. HUNT. E. & S. Livingstone, Edinburgh & London, 1964. Pp. 87. 12/6d. This small volume contains the proceedings of a symposium held at the Royal Society os Medicine, London, in November 1963. It contains contributions by fourteen leading workers in this field whose names are already well known. As might be expected the standard is very high. Dr. Simmonds who was chairman and, with Dr. Hunt, editor of this book may be congratulated on the result. It would be pointless to single out individual contributions, for these were made by plwsicians, bacteriologists, physiologists, almoners, epidemiologists and others whose work is not easily comparable. The book is well worth reading.
How to Interpret Pleuropulmonary Radiology L. BABAIANTZand F. CARDIS, Tr. by F. Bauer, Wright, Bristol, 1964. Pp. 99. 1 Is. 6d. This book will attract through its low price. But the reader, unless he is completely new to the subject, may be disappointed. The illustrations are line drawings, which are in general inadequate for teaching recognition of x-ray shadows. The classification of pulmonary tuberculosis will be unfamiliar to many readers. Few in this country would agree with the statement that 'it is impossible to follow-up seriously a patient with pulmonary tuberculosis without recourse to a fluoroscopic check at first weekly, later twice a month and monthly . . . . it is impossible to judge the real value of treatment without serial radiographs and tomograms alternating monthly, or at least every 2 or 3 months'. It seems unnecessary to include such a procedure as Monaldi drainage. Bronchial carcinoma surely merits more than 2~ pages. The style of the translation is at times somewhat inelegant.
392
LETTER
T H I A C E T A Z O N E IN BRITISH PATIENTS Since my original communication (Tubercle, 1964, 45, 188) there have been two more toxic episodes with this drug regime. Ore of the thirteen original patients, wl~o was aged 78, intolerant of PAS and had had nine months of uneventful treatment, suddenly developed a severe generalized exfoliative dermatitis, with oedema and severe malaise. The eosinophils numbered 26~, of 10,000 white cells. A test dose of thiacetazone, but not of isoniazid, caused it brisk exacerbation of the rash, which slowly subsided with the administration of steroids. Two more patients have been given thiacetazone and isoniazid. One, a woman aged 29, had severe reactions to PAS and streptomycin. Five weeks after starting thiacetazone and isoniazid, the S.G.P.T. suddenly rose to 122 Reitman-Frankel units. The drugs were stopped but ten weeks later the S.G.P.T. is still 82 units. The second patient was completely intolerant of PAS and ethionamide and had cultures resistant to streptomycin and pyrazinamide: he has taken thiacetazone and isoniazid without intoward effects for five months and now has negative cultures. Over half (8) of the 15 patients treated with thiacetazone and isoniazid have had serious sideeffects. Where a companion drug for isoniazid is required other than PAS or streptomycin, it would be advisable to use less toxic drugs such as ethionamide first. In British patients, thiacetazone should be given only when ethionamide in sufficient dose cannot be tolerated, and always with regular examinations of the blood.
Ware Park Hospital, Ware, Hefts.
A. PINES
BOOK
REVIEWS
Chemotherapy of Tuberculosis. Ed. by V. C. BARRY,Butterworths, London, 1964. Pp. 281. s
19 6d.
There is no more important aspect of the control of tuberculosis than the correct application of chemotherapy. With the increasing number of patients who secrete drug resistant organisms and the appearance of numbers of anti-tuberculosis drugs 'secondary' to streptomycin, PAS and isoniazid, cb,emotherapy has however become increasingly difficult. Few modern textbooks on tuberculosis deal with the subject adequately and the reader can only turn to medical journals for help. These, though useful, can at best provide only a fragmentary picture. This book is therefo're greatly to be welcomed, it gives to the application ofanti-tuberculosis drugs the sort of pre-eminence once occupied by pathology, epidemiology and, later, surgery, it appears none too soon. The current estimate of 15,000,000 persons throughout tile world suffering from tuberculosis is probably conservative, and it is doubtful whether, as drug resistance becomes more widespread, the disease will be conquered without further new drugs. This book is well written. A group of eleven doctors from Western Europe each contribute a chapter. Their purpose, as the editor remarks in a helpful preface, has been to contribute chapters on the present state of each subject rather than review articles. As a result a volume has emerged
BOOK REVIEWS
393
wllich is probably the most authoritative as well as the most practical yet to appear on the subject. It is a mine of information, but like many mines, requires hard work to obtain a good yield. This is a reflection on the complexity of the topic, not the clarity of the writing; for this is excellent. The book opens with a chapter by two Frencll professors of biochemistry--Asselineau and Lederer. One on bacterial pathogenicity and cl'temotherapy follows from Bloch of Switzerland. Barry, of the Medical Research Council of Ireland discusses the development of chemotherapeutic agents. Meissner of Germany, writes on the bacteriology of the tubercle bacillus, and Winder of Ireland follows with a chapter on the antibacterial action of streptomycin, isoniazid and PAS. Conalty, also from the Medical Research Council of Ireland, contributes a chapter on the pre-clinical evaluation of anti-tuberculosis drugs. Canetti and Rist have written valuable chapters on host factors, and drug resistance. All these contributions lead naturally to the final two chapters ~ t h e clinical evaluation of anti-tuberculous drugs by Crofton and the current states of chemotherapy in practice by Bignall. Though only 281 pages, this book is an almost complete review of the subject, containing well over one thousand references, and lacking only a chapter on pharmacology (through no fault of the editor), it is likely to command a wide readership in the field of tuberculous disease, perhaps as much amongst tl~ose engaged in research as in clinical practice. Most scientific work profits by the pursuit of informed 'launches'. The brief section, a single page, on trends in future development of chemotherapy, which concludes the book, will provide research workers and others with. as much guidance to the future as any more lengthy contribution by those, who like all of us in the field of tuberculous disease, can only feel that we 'see in a glass darkly'.
Some Aspects of Chronic Bronchitis. By F. A. H. SIMMONDSand L. B. HUNT. E. & S. Livingstone, Edinburgh & London, 1964. Pp. 87. 12/6d. This small volume contains the proceedings of a symposium held at the Royal Society os Medicine, London, in November 1963. It contains contributions by fourteen leading workers in this field whose names are already well known. As might be expected the standard is very high. Dr. Simmonds who was chairman and, with Dr. Hunt, editor of this book may be congratulated on the result. It would be pointless to single out individual contributions, for these were made by plwsicians, bacteriologists, physiologists, almoners, epidemiologists and others whose work is not easily comparable. The book is well worth reading.
How to Interpret Pleuropulmonary Radiology L. BABAIANTZand F. CARDIS, Tr. by F. Bauer, Wright, Bristol, 1964. Pp. 99. 1 Is. 6d. This book will attract through its low price. But the reader, unless he is completely new to the subject, may be disappointed. The illustrations are line drawings, which are in general inadequate for teaching recognition of x-ray shadows. The classification of pulmonary tuberculosis will be unfamiliar to many readers. Few in this country would agree with the statement that 'it is impossible to follow-up seriously a patient with pulmonary tuberculosis without recourse to a fluoroscopic check at first weekly, later twice a month and monthly . . . . it is impossible to judge the real value of treatment without serial radiographs and tomograms alternating monthly, or at least every 2 or 3 months'. It seems unnecessary to include such a procedure as Monaldi drainage. Bronchial carcinoma surely merits more than 2~ pages. The style of the translation is at times somewhat inelegant.