Interventions for Tuberculosis Control and Elimination 2002

In a third prospective study in the United Kingdom, various regimens
using isoniazid plus rifampicin throughout were compared. 537 The control
regimen was the same as the nine-month regimen in the British Thoracic
Society. One of the experimental regimens had the same duration, but
ethambutol was replaced by pyrazinamide. The second experimental arm
received the same regimen as the first, but for only six months. No differences
among the three regimens were found.
A review of published materials concludes that a six-month regimen
similar to that used in pulmonary tuberculosis is also adequate for treatment
of tuberculosis of peripheral lymph nodes. 538
It was noted in the British trials that tuberculosis of peripheral lymph
nodes does not always appear to respond clinically to treatment, and treatment
may be declared a failure on clinical grounds. Cultures from nodes
that were newly developing during treatment or from abscesses from newly
draining nodes subsequent to treatment completion remained bacteriologically
sterile. It has been postulated that the phenomenon is caused by an
immunologic response to tuberculo-protein. 535
Tuberculosis of the spine
Tuberculosis of the spine is one of the most important extrapulmonary forms
of tuberculosis both in terms of relative frequency and the substantial potential
of permanent disability. It has been estimated that more than half of
all osteoarticular manifestations of tuberculosis in India affect the spine. 539
Before the advent of anti-tuberculosis chemotherapy, treatment consisted
of bed-rest, improvement of the patient’s nutritional status, and, in
some cases, posterior spinal fusion. 540
In the 1950s and early 1960s, two extreme positions marked the divergence
of opinions about the appropriate approach to the treatment of tuberculosis
of the spine. In Nigeria, successful treatment with chemotherapy
alone was reported. 541,542 In Hong Kong, excellent results were reported
with anterior spinal fusion. 543-546
It was against this background that the British Medical Research
Council planned 539,547,548 and conducted a series of controlled clinical trials,
resulting in 14 scientific reports. 549-562
The trials were conducted in Hong Kong, India, Korea, and Zimbabwe.
All trials evaluated the role of chemotherapy and various operative and nonoperative
surgical procedures. Chemotherapy lasted from six to 18 months
at various points in time. The most recent trial established that a regimen
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