肺結核初回治療におけるSM・EB・INH併翔療法の評価

It was previously reported that the treatment for newly found pulmonary tuberculous patients with SM⋅INH⋅EB was clinically more effective than SM⋅INH⋅PAS regimen in respect of the negative conversion rate of tubercle bacilli in sputum and roentgenological improvement. To confirm these findings, the therapeutic effect of various regimens including SM⋅PAS⋅INH and EB were compared in experimental tuberculosis of mice.<BR>The results obtained were as follows:<BR>1) Albino dd/y male mice about 20 g b ody weight were infected intravenously with H₃₇Rv (3.8 × 10⁵/ml) strain. On the fourth day of infection, the mice were divided into the following 8 groups; SM⋅EB⋅INH⋅EB⋅INH, SM⋅PAS⋅INH⋅PAS⋅INH, INH, EB, PAS, and untreated control. SM (20 mg/kg) was given intramuscularly twice a week, and PAS (200 mg/kg), INH (4 mg/kg) and EB (30 mg/kg) were given orally once a day. The treatment was continued for 2 weeks in the half of these groups and for 3 weeks in the remaining. After two weeks treatment, the therapeutic effects were evaluated by comparing the viable unit of tubercle bacilli in the lungs and spleen of the mice in each group. The viable unit of bacilli among groups treated for 2 weeks was less in SM⋅EB⋅INH and EB⋅INH group than in SM⋅PAS⋅INH and PAS⋅INH groups. Same result was observed in the groups treated for three weeks.<BR>2) Pathological investigations were simultaneously performed on the specimens taken from the lungs. Findings were divided into the following 3 categories; (+), (-), and (±): (+)represents the peribronchial monocytes infiltration, grouping of epitheloid cells and the lymphocytes infiltration in every parts of the lung, (-) indicates normal finding, and (±)indicates the one between (+) and (-). Among groups treated with PAS and untreated control, many tuberculous lesions were found in the lungs after two and three weeks treatment and the finding was classified as (+). On the other hand, most of mice were classified as (-) or (±) among the groups treated with SM⋅EB⋅INH, SM⋅PAS⋅INH, EB⋅INH, PAS⋅INH, EB alone, and INH alone.<BR>3) Albino dd/y male mice were infected intravenously with Kurono (6.6×10⁵/ml) strain and treated for ten days with the same combination of drugs as described above. Survival time was observed in these 9 groups. The antituberculous agents were administered as follows; SM (20 mg/kg) intramuscularly twice weekly, INH (0.05 mg/kg), PAS (200 mg/kg )and EB (30 mg/kg) orally once daily.<BR>All animals of the SM treated and control groups died soon after the cessation of treatment, and a similar but slightly better result was seen in PAS treated group. INH group survived for a comparatively longer period in spite of minimal dose of INH. Combined and single therapy of SM⋅EB⋅INH, EB⋅INH and EB was found to be more effective than that of SM⋅PAS⋅INH and PAS⋅INH. The dose of EB evaluated on body weight base was higher than that of PA S, and it might be one of the reasons for better results with EB.<BR>In summary, it may be concluded that EB is more valua ble than PAS when it is combined with INH.