Drugs for combined therapy: experimental studies on the antileprosy activity of ethionamide and prothionamide, and a general review.
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In newly discovered patients with cavitary forms of pulmonary tuberculosis treatment with rifampicin, in association with other drugs, leads to recovery (negativation) in 69,6 percent of the patients in 3 months, in 92 per cent after 6 months and in 94,6 percent after 9 months of treatment. Closure of cavities is found in 23,4 percent, 64,5 percent and 76,6 percent of all patients at the corresponding time intervals. Comparisons of the various regimens of chemotherapy which include rifampicin showed that the maximal efficiency was obtained with rifampicin, ioniazid and a third drug (either etambutol or protionamide). The time intervals for the disappearence of bacilli and for the closure of cavities depend to a great extent on the degree of development of the pathological process, on the type of the lesions and the intensity of bacilli elimination at the start of the treatment. The use of rifampicin in new patients, in association with other drugs, leads to a rapid negativation, a shortening of the time necessary for the closure of cavities, especially in patients in whom the disappearence of the bacilli from the sputum occurs in the first three months.
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Because a 13% incidence of hepatotoxicity was observed in a first study of multibacillary leprosy patients treated daily with dapsone, rifampin, and 10 mg/kg thioamide, the patients were treated in a second study with 5 mg/kg thioamide in daily combination with dapsone and rifampin. In this study, monthly assessments of liver function were performed in order to detect early hepatic disturbances. Despite the reduced dosage of thioamide, a 16.5% incidence of hepatotoxicity was observed among 110 multibacillary patients. However, jaundice was observed in only 2 out of 18 cases of hepatotoxicity (11%); whereas it was observed in 5 out of the 7 cases of hepatotoxicity (71%) in the first study (p less than 0.05). The decrease in the thioamide dosage and the performance of monthly assessments of liver function did not decrease the incidence of hepatotoxicity but did decrease its severity. It is concluded that thioamide should not be used in daily combination with rifampin unless the daily dose is 5 mg/kg and monthly assessments of liver function are routinely performed.
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