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Relapse in tuberculosis

Tripathy, S P (1981) Relapse in tuberculosis. Indian Journal of Tuberculosis, 28 (2). pp. 45-57. ISSN 0019-5705

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At the outset, I would like to express my sincere gratitude to the Tuberculosis Association of India for having bestowed upon the coveted Wander-TAI Oration Award. When I think of the illustrious personalities who have preceded me I began to have doubts as to whether I will be able to do justice to today's occasion. If I fail to come up to your expectations it will not be because of lack of honest efforts on my part - it is because I neither have the scientific stature nor the gray hairs which my predecessors had. I sincerely hope you will view it in the proper spirit and condone any lapses in my presentation. We are about to celebrate the centenary of the discovery of the tubercle bacilli by Robert Koch. It is less than 4 decades since we have had the benefits of chemotherapeutic agents with specific activity against tuberculosis. Nevertheless, the decades following the discovery of streptomycin by Waksman in 1943 have seen spectacular achievements in chemotherapy of tuberculosis. We now have several anti-tuberculosis drugs - isoniazid, rifampicin, streptomycin, pyrazinamide, PAS, ethambutol, thioacetazone, ethionamide, and a few other drugs. Isoniazid is by far the most potent and most effective drug with a bacteriological activity, with rifampicin being a close second. Streptomycin and pyrazinamide also have bactericidal activity, and like isoniazid and rifampicin, cause death of tubercle bacilli. Drugs such as PAS, ethambutol and thioacetazone have a bacteriostatic activity, that is, they prevent the multiplication of the bacilli, so that the elimination of the bacilli would depend upon the defense mechanism of the host; their utility is limited to their being companion drugs given in combination with isoniazid with the object of preventing the multiplication of isoniazid-resistant mutants. The present day management of tuberculosis consists of treatment with a combination of isoniazid with at least one other drug in appropriate dosages and rhythms for periods upto 24 months. With a judicatious choice of drug regimens containing isoniazid and other drugs it is possible to produce rapid sputum conversion to negativity and to eliminate the possibility of emergence of drug-resistance; further, patients attaining bacteriological quiescence continue to have quiescent disease even after stopping chemotherapy. With inadequate chemotherapy, on the other hand, failures may manifest in one or more ways - sputum may fail to become culture negative, drug-resistance may emerge, or sputum conversion occurs during treatment but culture becomes positive again after treatment is discontinued, that is, the patient has a bacteriological relapse. With the advent of highly effective chemotherapeutic regimens with practically 100% efficacy, bacteriological relapse has become the most crucial factor in determining the relative merits of chemotherapeutic regimens. I have, therefore, chosen the subject of relapse for today's oration.

Item Type: Article
Subjects: Tuberculosis > Clinical Research
Divisions: Clinical Research
Depositing User: Dr. Rathinasabapati R
Date Deposited: 31 Jul 2013 07:00
Last Modified: 14 Mar 2016 08:55

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