[The role of surgery in pulmonary tuberculosis infected by tubercle bacilli with multiple drug resistance].
The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989. Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation. 2) 52% were more than 50 years old. One third showed less than 40 in respiratory index. 3) Most of them did not have effective anti-tuberculosis drug to be used after operation. 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty. 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases. But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25%. Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs. Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.
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Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo.
D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D011013:Pneumonectomy; D014397:Tuberculosis, Pulmonary / Q000382:microbiology / Q000601:surgery*
D000995:Antitubercular Agents