BACTERIAL DISEASES Pulmonary disease caused by these less virulent of tuberculosis-like cervical adenitis (scrofula) agents is actually much more difficult to treat than drug-susceptible tuberculosis. In disease caused by M. kansasii, multiple drug therapy may be moderately helpful and is always used. In disease caused by M. intracellular, the use of drugs is generally disappointing, and drugs are probably entirely ineffective against M. fortuitous. These organisms almost always show in vitro resistance to isoniazid. This drug is generally used, however. In disease caused by M. kansasii, a combination of ionized, ethionamide, ethambutol, and streptomycin has been reported to produce the best results.
The susceptibilities of the organism to all drugs should be obtained and the most appropriate combination of several drugs continued. There is no established plan for drug management of dis-ease caused by M.intracellulare. Although some A762),12.69 Are susceptible to some of the drugs, this is quite unpredictable. The most commonly used drugs are ethambutol, ethionamide, pyrazinamide, and cycloserine (in addition to ionized). Multiple drugs increase the chance of success but at greater risk of drug toxicity. When thought is effective, drugs are usually continued in both infections for one year after the organism has disappeared from the sputum.
BACTERIAL DISEASES To the degree that drug therapy is less useful, other methods of treatment become more so. Most authors recommend hospitalization and a fairly confining type of rest therapy. Most agree that residual cavities should be respected if possible,
Whether or not the bacilli have disappeared from the sputum. This argument is stronger in the case of caused by M. intracellular than that by M. kansasii and is more compelling if the bacilli persist in the sputum despite nonsurgical treatment. The incidence of surgical complications is remarkably low even without effective drug coverage.
A statement of prognosis must be quite broad. Without treatment, the prognosis is generally bad. In disease caused by M. kansasii, the results are generally better in those without prior lung dis-ease than in those with bronchitis and emphysema. Persistence of the bacilli in the sputum in the face of drug treatment indicates an unflavored-able outlook. The presence of residual capitation,
Even with “negative” sputum, carries a high risk of relapse. With vigorous treatment, the best success rates in pulmonary disease caused by M. hansasii are reported to be in the range of 85 percent, and in disease caused by M.intracellulare a maximum of 75 percent.