Interventions for Tuberculosis Control and Elimination 2002

Thioacetazone replaced para-aminosalicylic acid very rapidly throughout
English-speaking sub-Saharan Africa because of the better tolerance and
important cost savings.
Isoniazid plus rifampicin
With the introduction of rifampicin, a more rapid conversion was demonstrated
when it replaced streptomycin (figure 48). 487 This was, however, not
the main progress made with rifampicin-containing chemotherapy. In a trial
in France, rifampicin-containing regimens were tested in three different dura-
Per cent positive
100
80
60
40
20
0
RMP+INH+EMB
0 4 8 12 16 20
Month of treatment
66
SM+INH+EMB
Figure 48. Effect of replacing streptomycin by rifampicin on culture conversion. 487
tions of chemotherapy: six, nine, and 12 months. 502,503 It was demonstrated
that nine months of isoniazid plus rifampicin, supplemented by either ethambutol
or streptomycin during the first three months, was the optimum duration,
502 and the relapse rate during a remarkable mean follow-up time of
101 months with this regimen was only two out of 85 patients. 503
The use of rifampicin provided curative treatment of less than one
year’s duration, and the term “short-course chemotherapy” became the brand
name of this new successful strategy. 504
Isoniazid plus rifampicin plus pyrazinamide (plus a fourth drug)
Despite its remarkable efficacy in experimental models, 505,506 pyrazinamide
was not retained in routine chemotherapy because of its hepatotoxicity.