Tuberc Respir Dis.  2005 Aug;59(2):179-185.

Pulmonary Resection Combined with Isoniazid-and Rifampin-based Drug Therapy for Patients with Multidrug-resistant Tuberculosis

Affiliations
  • 1Department of chest surgery, National Masan Tuberculosis Hospital, Masan, Korea. pulmo116@empal.com

Abstract

BACKGROUND: To evaluate the clinical efficacy of pulmonary resection combined with first-line antituberculous drug therapy in patients with well-localized, cavities-containing pulmonary multidrug-resistant tuberculosis (MDR-TB). METHOD: From February 1998, seventeen patients with well-localized, cavities-containing pulmonary MDR-TB were enrolled and followed prospectively up to December 2004. After radical pulmonary resection, the patients were treated with antituberculous drugs comprising of isoniazid (H), rifampin (R), pyrazinamide (Z), ethambutol (E), and streptomycin (S) (3HERZS/3HERS/6HER).
RESULTS
All recovered isolates of M. tuberculosis were resistant to both isoniazid and rifampin, and to a mean of 4.8 antituberculous drugs (range, 2 to 7 drugs). Surgical procedures included lobectomy (13 patients), lobectomy plus segmentectomy (3 patients), and pneumonectomy (1 patient). The median time for postoperative sputum smear and culture conversion was 2 days (range, 1 to 23 days). Fifteen (94%) patients had durable cures (mean follow-up period, 39.0 months). One patient failed to convert her sputum and was successfully switched to second-line therapy; one patient developed active disease again almost 7 years later, likely due to re-infection with a new M tuberculosis strain.
CONCLUSION
Radical resection combined with administration of first-line antituberculous agents was effective in patients with well-localized, cavities-containing pulmonary MDR-TB.

Keyword

Pulmonary tuberculosis; MDR-TB; Lung surgery

MeSH Terms

Drug Therapy*
Ethambutol
Follow-Up Studies
Humans
Isoniazid
Mastectomy, Segmental
Pneumonectomy
Prospective Studies
Pyrazinamide
Rifampin
Sputum
Streptomycin
Tuberculosis
Tuberculosis, Multidrug-Resistant*
Tuberculosis, Pulmonary
Ethambutol
Isoniazid
Pyrazinamide
Rifampin
Streptomycin
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